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Mangan JM, Hedges KNC, Salerno MM, Tatum K, Bouwkamp B, Frick MW, McKenna L, Muzanyi G, Engle M, Coetzee J, Yvetot J, Elskamp M, Lamunu D, Tizora MET, Namutamba D, Chaisson RE, Swindells S, Nahid P, Dorman SE, Kurbatova E. Facilitators and barriers to adolescent participation in a TB clinical trial. Int J Tuberc Lung Dis 2024; 28:243-248. [PMID: 38659142 DOI: 10.5588/ijtld.23.0519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND The inclusion of adolescents in TB drug trials is essential for the development of safe, child-friendly regimens for the prevention and treatment of TB. TB Trials Consortium Study 31/AIDS Clinical Trials Group A5349 (S31/A5349) enrolled adolescents as young as 12 years old. We assessed investigator and coordinator described facilitators and barriers to adolescent recruitment, enrollment, and retention.METHODS Interviews were conducted with six investigators from sites that enrolled adolescent participants and six investigators from non-enrolling sites. Additionally, two focus groups were conducted with study coordinators from enrolling sites and two focus groups with non-enrolling sites. Discussions were transcribed, analyzed, summarized, and summaries were reviewed by Community Research Advisors Group members and research group representatives for content validity.RESULTS Investigators and coordinators attributed the successful enrollment of adolescents to the establishment and cultivation of external partnerships, flexibility to accommodate adolescents' schedules, staff engagement, recruitment from multiple locations, dedicated recruitment staff working onsite to access potential participants, creation of youth-friendly environments, and effective communications. Non-enrolling sites were mainly hindered by regulations. Suggestions for improvement in future trials focused on study planning and site preparations.CONCLUSION Proactive partnerships and collaboration with institutions serving adolescents helped identify and reduce barriers to their inclusion in this trial..
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Affiliation(s)
- J M Mangan
- Division of Tuberculosis Elimination, Centers for Disease Control, Atlanta, GA
| | - K N C Hedges
- Division of Tuberculosis Elimination, Centers for Disease Control, Atlanta, GA
| | - M M Salerno
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, New York, NY
| | - K Tatum
- Division of Tuberculosis Elimination, Centers for Disease Control, Atlanta, GA
| | - B Bouwkamp
- Division of Tuberculosis Elimination, Centers for Disease Control, Atlanta, GA, Oak Ridge Institute for Science and Education
| | - M W Frick
- Treatment Action Group, New York, NY, USA
| | - L McKenna
- Treatment Action Group, New York, NY, USA
| | - G Muzanyi
- Uganda-Case Western Reserve University Research Collaboration, Kampala, Uganda
| | - M Engle
- UTHSCSA & San Antonio Veterans Administration Medical Center, TX, USA
| | - J Coetzee
- Family Centre for Research with Ubuntu, University of Stellenbosch, Capetown, South Africa
| | - J Yvetot
- Les Centres GHESKIO, Port Au Prince, Haïti
| | - M Elskamp
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, New York, NY
| | - D Lamunu
- Uganda National Council for Science and Technology, Kampala, Uganda
| | - M E Theunissen Tizora
- Family Centre for Research with Ubuntu, University of Stellenbosch, Capetown, South Africa
| | - D Namutamba
- International Community of Women Living with HIV Eastern Africa, Bujumbura, Burundi
| | | | - S Swindells
- University of Nebraska Medical Center, Omaha, NE
| | - P Nahid
- UCSF Center for Tuberculosis, University of California, San Francisco, CA
| | - S E Dorman
- Medical University of South Carolina, Charleston, SC, USA
| | - E Kurbatova
- Division of Tuberculosis Elimination, Centers for Disease Control, Atlanta, GA
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Jewkes R, Milovanovic M, Otwombe K, Hlongwane K, Hill N, Mbowane V, Gray G, Coetzee J. Understanding drivers of female sex workers' experiences of external/enacted and internalised stigma: findings from a cross-sectional community-centric national study in South Africa. Cult Health Sex 2023; 25:1433-1448. [PMID: 36592099 DOI: 10.1080/13691058.2022.2160014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 12/14/2022] [Indexed: 01/03/2023]
Abstract
To deepen our understanding of sex work stigma, and to its drivers and their interrelation, we conducted an analysis using structural equation modelling of the South African National Sex Worker Survey. We enrolled 3005 women in sex work using multi-stage sampling across all South Africa's provinces. Experience of external/enacted and internalised stigma was widespread. Non-partner rape, intimate partner violence and partner controlling behaviour (often expressions of external/enacted stigma) compounded internalised stigma. These experiences of violence, other manifestations of external/enacted stigma and food insecurity, were key drivers of internalised stigma, and often had an impact on mental health. We found that considerable protection against stigma emanated from viewing sex work positively. This resistance to stigma provided opportunities to shift the narrative. Reducing sex workers' exposure to external/enacted stigmatising behaviour, including by enabling more to work indoors, and providing greater protection from partner violence and rape, are critical for better health and well-being. Ending the criminalisation of sex work is foundational for safer working conditions and better health outcomes for sex workers, similarly providing adequately funded mental and physical health and social care through sex work specific programmes.
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Affiliation(s)
- Rachel Jewkes
- Gender & Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- Office of the President, South African Medical Research Council, Tygerberg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Minja Milovanovic
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
- African Potential Foundation, Kyalami, South Africa
| | - Kennedy Otwombe
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
| | - Khuthadzo Hlongwane
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
| | - Naomi Hill
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Hillbrow, South Africa
| | - Venice Mbowane
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
| | - Glenda Gray
- Office of the President, South African Medical Research Council, Tygerberg, South Africa
| | - Jenny Coetzee
- Gender & Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
- African Potential Foundation, Kyalami, South Africa
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Stone J, Looker KJ, Silhol R, Turner KME, Hayes R, Coetzee J, Baral S, Schwartz S, Mayaud P, Gottlieb S, Boily MC, Vickerman P. The population impact of herpes simplex virus type 2 (HSV-2) vaccination on the incidence of HSV-2, HIV and genital ulcer disease in South Africa: a mathematical modelling study. EBioMedicine 2023; 90:104530. [PMID: 36933410 PMCID: PMC10034427 DOI: 10.1016/j.ebiom.2023.104530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 03/03/2023] [Accepted: 03/03/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Evidence suggests HSV-2 infection increases HIV acquisition risk and HIV/HSV-2 coinfection increases transmission risk of both infections. We analysed the potential impact of HSV-2 vaccination in South Africa, a high HIV/HSV-2 prevalence setting. METHODS We adapted a dynamic HIV transmission model for South Africa to incorporate HSV-2, including synergistic effects with HIV, to evaluate the impact of: (i) cohort vaccination of 9-year-olds with a prophylactic vaccine that reduces HSV-2 susceptibility; (ii) vaccination of symptomatically HSV-2-infected individuals with a therapeutic vaccine that reduces HSV shedding. FINDINGS An 80% efficacious prophylactic vaccine offering lifetime protection with 80% uptake could reduce HSV-2 and HIV incidence by 84.1% (95% Credibility Interval: 81.2-86.0) and 65.4% (56.5-71.6) after 40 years, respectively. This reduces to 57.4% (53.6-60.7) and 42.1% (34.1-48.1) if efficacy is 50%, 56.1% (53.4-58.3) and 41.5% (34.2-46.9) if uptake is 40%, and 29.4% (26.0-31.9) and 24.4% (19.0-28.7) if protection lasts 10 years. An 80% efficacious therapeutic vaccine offering lifetime protection with 40% coverage among symptomatic individuals could reduce HSV-2 and HIV incidence by 29.6% (21.8-40.9) and 26.4% (18.5-23.2) after 40 years, respectively. This reduces to 18.8% (13.7-26.4) and 16.9% (11.7-25.3) if efficacy is 50%, 9.7% (7.0-14.0) and 8.6% (5.8-13.4) if coverage is 20%, and 5.4% (3.8-8.0) and 5.5% (3.7-8.6) if protection lasts 2 years. INTERPRETATION Prophylactic and therapeutic vaccines offer promising approaches for reducing HSV-2 burden and could have important impact on HIV in South Africa and other high prevalence settings. FUNDING WHO, NIAID.
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Affiliation(s)
- Jack Stone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Katharine Jane Looker
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Romain Silhol
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | | | - Richard Hayes
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Jenny Coetzee
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; South African Medical Research Council, Cape Town, South Africa
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sheree Schwartz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Philippe Mayaud
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Sami Gottlieb
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Marie-Claude Boily
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, Bristol, UK
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Stone J, Bothma R, Gomez GB, Eakle R, Mukandavire C, Subedar H, Fraser H, Boily M, Schwartz S, Coetzee J, Otwombe K, Milovanovic M, Baral S, Johnson LF, Venter WDF, Rees H, Vickerman P. Impact and cost-effectiveness of the national scale-up of HIV pre-exposure prophylaxis among female sex workers in South Africa: a modelling analysis. J Int AIDS Soc 2023; 26:e26063. [PMID: 36807874 PMCID: PMC9939943 DOI: 10.1002/jia2.26063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 01/30/2023] [Indexed: 02/22/2023] Open
Abstract
INTRODUCTION In 2016, South Africa (SA) initiated a national programme to scale-up pre-exposure prophylaxis (PrEP) among female sex workers (FSWs), with ∼20,000 PrEP initiations among FSWs (∼14% of FSW) by 2020. We evaluated the impact and cost-effectiveness of this programme, including future scale-up scenarios and the potential detrimental impact of the COVID-19 pandemic. METHODS A compartmental HIV transmission model for SA was adapted to include PrEP. Using estimates on self-reported PrEP adherence from a national study of FSW (67.7%) and the Treatment and Prevention for FSWs (TAPS) PrEP demonstration study in SA (80.8%), we down-adjusted TAPS estimates for the proportion of FSWs with detectable drug levels (adjusted range: 38.0-70.4%). The model stratified FSW by low (undetectable drug; 0% efficacy) and high adherence (detectable drug; 79.9%; 95% CI: 67.2-87.6% efficacy). FSWs can transition between adherence levels, with lower loss-to-follow-up among highly adherent FSWs (aHR: 0.58; 95% CI: 0.40-0.85; TAPS data). The model was calibrated to monthly data on the national scale-up of PrEP among FSWs over 2016-2020, including reductions in PrEP initiations during 2020. The model projected the impact of the current programme (2016-2020) and the future impact (2021-2040) at current coverage or if initiation and/or retention are doubled. Using published cost data, we assessed the cost-effectiveness (healthcare provider perspective; 3% discount rate; time horizon 2016-2040) of the current PrEP provision. RESULTS Calibrated to national data, model projections suggest that 2.1% of HIV-negative FSWs were currently on PrEP in 2020, with PrEP preventing 0.45% (95% credibility interval, 0.35-0.57%) of HIV infections among FSWs over 2016-2020 or 605 (444-840) infections overall. Reductions in PrEP initiations in 2020 possibly reduced infections averted by 18.57% (13.99-23.29). PrEP is cost-saving, with $1.42 (1.03-1.99) of ART costs saved per dollar spent on PrEP. Going forward, existing coverage of PrEP will avert 5,635 (3,572-9,036) infections by 2040. However, if PrEP initiation and retention doubles, then PrEP coverage increases to 9.9% (8.7-11.6%) and impact increases 4.3 times with 24,114 (15,308-38,107) infections averted by 2040. CONCLUSIONS Our findings advocate for the expansion of PrEP to FSWs throughout SA to maximize its impact. This should include strategies to optimize retention and should target women in contact with FSW services.
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Affiliation(s)
- Jack Stone
- Population Health SciencesUniversity of BristolBristolUK
| | - Rutendo Bothma
- Wits RHIUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Gabriela B. Gomez
- Department of Global Health and DevelopmentLondon School of Hygiene and Tropical MedicineLondonUK
| | - Robyn Eakle
- Wits RHIUniversity of the WitwatersrandJohannesburgSouth Africa
- Department of Global Health and DevelopmentLondon School of Hygiene and Tropical MedicineLondonUK
- Office of HIV AIDSU.S. Agency for International Development (USAID)WashingtonDCUSA
| | - Christinah Mukandavire
- Population Health SciencesUniversity of BristolBristolUK
- Department of Infectious Disease EpidemiologyImperial College LondonLondonUK
| | | | - Hannah Fraser
- Population Health SciencesUniversity of BristolBristolUK
| | - Marie‐Claude Boily
- Department of Infectious Disease EpidemiologyImperial College LondonLondonUK
| | - Sheree Schwartz
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Jenny Coetzee
- Perinatal HIV Research UnitFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- South African Medical Research CouncilCape TownSouth Africa
- African Potential Management ConsultancyKyalamiSouth Africa
| | - Kennedy Otwombe
- Perinatal HIV Research UnitFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- School of Public HealthFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Minja Milovanovic
- Perinatal HIV Research UnitFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- African Potential Management ConsultancyKyalamiSouth Africa
| | - Stefan Baral
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Leigh F. Johnson
- Centre for Infectious Disease Epidemiology and ResearchUniversity of Cape TownCape TownSouth Africa
| | | | - Helen Rees
- Wits RHIUniversity of the WitwatersrandJohannesburgSouth Africa
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Kassanjee R, Welte A, Otwombe K, Jaffer M, Milovanovic M, Hlongwane K, Puren AJ, Hill N, Mbowane V, Dunkle K, Gray G, Abdullah F, Jewkes R, Coetzee J. HIV incidence estimation among female sex workers in South Africa: a multiple methods analysis of cross-sectional survey data. Lancet HIV 2022; 9:e781-e790. [PMID: 36075252 PMCID: PMC9626386 DOI: 10.1016/s2352-3018(22)00201-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Although numerous studies have investigated HIV risk factors and shown high HIV prevalence among female sex workers in South Africa, no national HIV incidence estimate exists for this potentially important group for HIV transmission. We aimed to estimate HIV incidence among female sex workers in South Africa who could be accessed through sex worker programmes, and to refine and describe the methods that enabled analysis. METHODS This study was embedded in a cross-sectional national survey of female sex workers who were linked to sex worker programmes. We aimed to enrol 3000 female sex workers aged at least 18 years who had sold or transacted in sex in the preceding 6 months in 12 randomly selected districts of the 22 districts with sex worker programmes, ensuring coverage of all provinces of South Africa. Women who self-reported as current victims of human trafficking were excluded from enrolment. We used a multistep process to sample districts and then hotspots, and a chain referral method to recruit participants. We collected cross-sectional data for self-reported HIV status, demographic characteristics, and exposure to violence. Two rapid tests were used to ascertain diagnostic markers, a viral load assay was used to ascertain clinical markers, and the Maxim Limiting Antigen Avidity EIA was used to ascertain infection-staging HIV markers. Given the challenges of estimating HIV incidence, especially cross-sectionally, multiple methods of estimation were adapted to our setting, leveraging the age structure of HIV prevalence, recency-of -infection biomarker results (ie, where recent infection is classified as ≤1·5 normalised optical density [ODn] on the avidity assay and viral load of ≥1000 copies per mL), and reported testing histories. FINDINGS Of 3005 female sex workers who were enrolled and interviewed between Feb 4 and June 26, 2019, 2999 who had HIV test results were included in this analysis. The median age of participants was 32 years (IQR 27-38). 1714 (57·2%) of 2999 participants self-reported as being HIV positive, and 1447 (48·3%) of 2993 participants reported client sexual violence in the past year. The measured HIV prevalence was 62·1% (95% CI 60·3-65·7) and peaked at approximately age 40 years. Using recency-of-infection biomarker results, we obtained a base case estimate of HIV incidence of 4·60 cases per 100 person-years (95% CI 1·53-8·45) for the population. Estimates were generally consistent by method, and outlying incidence estimates calculated by self-reported testing histories were considered unreliable. Various sensitivity analyses produced estimates up to 11 cases per 100 person-years, and we did not detect differences by age and region. INTERPRETATION We found that female sex workers have extraordinarily high HIV incidence of approximately 5 cases per 100 person-years, emphasising the need to sustain and strengthen efforts to mitigate risk and provide adequate care. The notable role that sex work has in HIV transmission demands substantial investment in ongoing epidemiological monitoring. FUNDING South African Medical Research Council, South African National Treasury, Global Fund, South African Department of Science and Innovation, Wellcome Trust.
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Affiliation(s)
- Reshma Kassanjee
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, University of Cape Town, Cape Town, South Africa; The South African Department of Science and Innovation-National Research Foundation, Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa.
| | - Alex Welte
- The South African Department of Science and Innovation-National Research Foundation, Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa
| | - Kennedy Otwombe
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Maya Jaffer
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Minja Milovanovic
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; African Potential Management Consultancy, Kyalami, South Africa
| | - Khuthadzo Hlongwane
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Adrian J Puren
- South African National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Naomi Hill
- Wits Reproductive Health Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Venice Mbowane
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kristin Dunkle
- South African Medical Research Council, Cape Town, South Africa
| | - Glenda Gray
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; South African Medical Research Council, Cape Town, South Africa
| | - Fareed Abdullah
- South African Medical Research Council, Cape Town, South Africa
| | - Rachel Jewkes
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; South African Medical Research Council, Cape Town, South Africa
| | - Jenny Coetzee
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; African Potential Management Consultancy, Kyalami, South Africa; South African Medical Research Council, Cape Town, South Africa
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Martin M, Kleinhenz M, Schwartzkopf-Genswein K, Melendez D, Marti S, Pajor E, Janzen E, Coetzee J. Characterizing the diagnostic sensitivity and specificity of pain biomarkers in cattle using receiver operating characteristic curves. J Dairy Sci 2022; 105:9853-9868. [DOI: 10.3168/jds.2021-21393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 07/18/2022] [Indexed: 11/05/2022]
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Jaffer M, Christofides N, Hlongwane K, Otwombe K, Milovanovic M, Hopkins KL, Matuludi M, Mbowane V, Abdullah F, Gray G, Jewkes R, Coetzee J. The HIV Cascade of Care and Service Utilisation at Sex Work Programmes Among Female Sex Workers in South Africa. AIDS Behav 2022; 26:2907-2919. [PMID: 35247114 PMCID: PMC8897612 DOI: 10.1007/s10461-022-03616-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2022] [Indexed: 11/30/2022]
Abstract
Female sex workers (FSWs) in South Africa experience a uniquely high prevalence of HIV. We describe the HIV cascade of care (CoC) in FSWs in South Africa, and explored service utilisation at sex work programmes. A cross-sectional, study enrolled FSWs across 12 sites in South Africa. Participants were recruited using chain-referral method. Inclusion criteria: ≥ 18 years, cis-gender female, sold/transacted in sex, HIV positive. 1862 HIV positive FSWs were enrolled. 92% were known positive, 87% were on antiretroviral treatment (ART). Of those on ART, 74% were virally suppressed. Younger FSWs were significantly less likely to be on ART or virally suppressed. Female sex workers using HIV services from specialised programs were 1.4 times more likely to be virally suppressed than non-program users. The pre-COVID-19 pandemic HIV CoC amongst FSWs in South Africa shows striking improvement from previous estimates, and approaches achievement of 90:90:90 goals.
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Affiliation(s)
- Maya Jaffer
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicola Christofides
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Khuthadzo Hlongwane
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kennedy Otwombe
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Minja Milovanovic
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- African Potential Management Consultancy, Kyalami, South Africa
| | - Kathryn L Hopkins
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Mokgadi Matuludi
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Venice Mbowane
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Fareed Abdullah
- Office of AIDS and TB Research, South African Medical Research Council, Pretoria, South Africa
| | - Glenda Gray
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Office of AIDS and TB Research, South African Medical Research Council, Pretoria, South Africa
- Office of the President, South African Medical Research Council, Cape Town, South Africa
| | - Rachel Jewkes
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Office of AIDS and TB Research, South African Medical Research Council, Pretoria, South Africa
- Office of the President, South African Medical Research Council, Cape Town, South Africa
| | - Jenny Coetzee
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- African Potential Management Consultancy, Kyalami, South Africa.
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Coetzee J, Mbowane V, Mlambo F, Ndlovu P, Rasego B, Milovanovic M. Whose role is it anyways: Knowledge generation within the scope of sex work. Glob Public Health 2022; 17:2268-2279. [PMID: 35544457 DOI: 10.1080/17441692.2022.2063921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Research within the context of sex work is challenging. The nature of the subject matter and stigma that surrounds sex work has often privileged a homogenous, academic practice of generating knowledge. Based on the lessons and experiences of an existing sex work programme and a recently completed national public health study with female sex workers (FSWs) in South Africa, we aim to highlight the significance and successes of privileging a bottom-up, community centric approach to the design, data collection, and knowledge generation. A FSW programme provided extensive peer educator skills training and learning opportunities. Lessons were applied to the implementation of a national study on FSW across South Africa. Planning workshops with community members and sites and pre- implementation training of all site staff was undertaken. 3005 FSWs were successfully enrolled and surveyed by their peers, over 6-months. Researchers have a lot to learn from community members and should remain vigilant to the power dynamics that their privilege creates throughout the research process. Those seeking to generate knowledge should practice meaningfully engagement and include population members on the study team in roles that allow them to proactively contribute to the process and create knowledge.
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Affiliation(s)
- Jenny Coetzee
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,South African Medical Research Council, Cape Town, South Africa.,African Potential Management Consultancy, Johannesburg, South Africa
| | - Venice Mbowane
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Fikile Mlambo
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Patricia Ndlovu
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Bontle Rasego
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Minja Milovanovic
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,African Potential Management Consultancy, Johannesburg, South Africa
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Milovanovic M, Jewkes R, Matuludi M, Dunkle K, Hlongwane K, Vanleeuw L, Slingers N, Jaffer M, Mbowane V, Abdullah F, Otwombe K, Gray G, Coetzee J. Sex work and young women: a cross sectional study to understand the overlap of age and sex work as a central tenet to epidemic control in South Africa. AIDS Care 2022; 35:555-563. [PMID: 35373670 DOI: 10.1080/09540121.2022.2057908] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Adolescent girls and young women (AGYW) engaging in sex-for-money transactions are at risk of HIV infection. A better understanding of the demographic, socio-economic factors and risks of HIV acquisition is required to guide appropriate public health interventions targeting young sex workers in South Africa. A cross-sectional survey of Female Sex Workers (FSWs), using a chain referral sampling method, was conducted across 12 sites in South Africa in 2019. Three thousand and five participants were enrolled and interviewed assessing demographic characteristics, sexual behaviour, substance use and HIV testing and treatment. Of 3005 women, 13.3% were ≤24 years old (young FSWs); of these, 60.0% entered sex work aged ≤19 years. Economic factors were the primary drivers of entry into sex work. HIV prevalence amongst young FSWs was 40.4%, with 12.4% recently infected. Younger FSWs were significantly less likely to know they were HIV positive (87.6% versus 92.1%), to report any ART exposure (75.2% versus 87.6%) and to be virally suppressed (58.1% versus 75.2%) compared to older FSWs. Our findings highlight that many FSWs enter sex work at a young age. It is essential to develop tailored services and interventions that improve access to HIV prevention and treatment services addressing specific needs.
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Affiliation(s)
- Minja Milovanovic
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa.,African Potential Management Consultancy (APMC), Johannesburg, South Africa
| | - Rachel Jewkes
- Gender & Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Mokgadi Matuludi
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
| | - Kristin Dunkle
- Gender & Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Khuthadzo Hlongwane
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
| | - Lieve Vanleeuw
- Office of AIDS and TB Research, South African Medical Research Council, Pretoria, South Africa
| | - Nevilene Slingers
- Office of AIDS and TB Research, South African Medical Research Council, Pretoria, South Africa
| | - Maya Jaffer
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
| | - Venice Mbowane
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
| | - Fareed Abdullah
- Office of AIDS and TB Research, South African Medical Research Council, Pretoria, South Africa
| | - Kennedy Otwombe
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Glenda Gray
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa.,Office of the President, South African Medical Research Council, Tygerberg, South Africa
| | - Jenny Coetzee
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa.,African Potential Management Consultancy (APMC), Johannesburg, South Africa.,Gender & Health Research Unit, South African Medical Research Council, Pretoria, South Africa
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10
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Yeo EJ, Hlongwane K, Otwombe K, Hopkins KL, Variava E, Martinson N, Strathdee SA, Coetzee J, Milovanovic M. Key risk factors for substance use among female sex workers in Soweto and Klerksdorp, South Africa: A cross-sectional study. PLoS One 2022; 17:e0261855. [PMID: 35061728 PMCID: PMC8782394 DOI: 10.1371/journal.pone.0261855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/10/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Sex workers in South Africa experience high levels of trauma and mental health issues, but little is known about their drug and alcohol use. This study assessed the prevalence of substance use and its key risk factors amongst female sex workers (FSWs) at two sites in South Africa. METHODS Two cross-sectional studies were conducted, in Soweto and Klerksdorp, South Africa. Using respondent-driven sampling (RDS) 508 FSWs in Soweto and 156 in Klerksdorp were enrolled. A study-specific survey was used to collect social and demographic information, substance use, mental ill-health, and HIV status. Raw and RDS-adjusted data were analyzed using Chi-squared tests of association. Weighted and unweighted Poisson regression models were used to assess key risk factors for alcohol and drug use at both univariate and multivariate levels. RESULTS Of the 664 FSWs, 56.2% were binge drinkers and 29.4% reported using drugs within the last year. Living in a home with regular food (RR: 1.2597, 95% CI: 1.1009-1.4413) and being HIV positive (RR: 1.1678, 95% CI: 1.0227-1.3334) were associated with a higher risk of binge drinking. Having symptoms suggestive of post-traumatic stress disorder (RR: 1.1803, 95% CI: 1.0025-1.3895) and past year physical/sexual abuse from either intimate (RR: 1.3648, 95% CI: 1.1522-1.6167) or non-intimate partners (RR: 1.3910, 95% CI: 1.1793-1.6407) were associated with a higher risk of drug use. DISCUSSION In conclusion, our findings demonstrate a high prevalence of alcohol and drug use among FSWs in Soweto and Klerksdorp with site-specific contextual dynamics driving substance use. Site differences highlight the importance of tailoring site-specific substance use harm mitigation for this key population.
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Affiliation(s)
- Ellis Jaewon Yeo
- Harvard Global Health Institute, Harvard University, Cambridge, Massachusetts, United States of America
| | - Khuthadzo Hlongwane
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of The Witwatersrand, Soweto, South Africa
| | - Kennedy Otwombe
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of The Witwatersrand, Soweto, South Africa
- School of Public Health, Faculty of Health Sciences, University of The Witwatersrand, Johannesburg, South Africa
| | | | - Ebrahim Variava
- School of Public Health, Faculty of Health Sciences, University of The Witwatersrand, Johannesburg, South Africa
| | - Neil Martinson
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of The Witwatersrand, Soweto, South Africa
- Department of Internal Medicine, Klerksdorp Tshepong Hospital Complex, University of The Witwatersrand, Matlosana, South Africa
- Johns Hopkins University Center for TB Research, Baltimore, Maryland, United States of America
| | - Steffanie A. Strathdee
- Department of Medicine, University of California San Diego, San Diego, California, United States of America
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Jenny Coetzee
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of The Witwatersrand, Soweto, South Africa
- South African Medical Research Council, Cape Town, South Africa
- African Potential Management Consultancy, Kyalami, South Africa
| | - Minja Milovanovic
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of The Witwatersrand, Soweto, South Africa
- African Potential Management Consultancy, Kyalami, South Africa
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11
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Milovanovic M, Jewkes R, Otwombe K, Jaffer M, Hopkins K, Hlongwe K, Mathaludi M, Mbowane V, Gray G, Dunkle K, Hunt G, Welte A, Kassanjee R, Slingers N, Vanleeuw L, Puren A, Kinghorn A, Martinson N, Abdullah F, Coetzee J. Community-led cross-sectional study of social and employment circumstances, HIV and associated factors amongst female sex workers in South Africa: study protocol. Glob Health Action 2021; 14:1953243. [PMID: 34338167 PMCID: PMC8330713 DOI: 10.1080/16549716.2021.1953243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background In South Africa, female sex workers (FSWs) are perceived to play a pivotal role in the country’s HIV epidemic. Understanding their health status and risk factors for adverse health outcomes is foundational for developing evidence-based health care for this population. Objective Describe the methodology used to successfully implement a community-led study of social and employment circumstances, HIV and associated factors amongst FSWs in South Africa. Method A community-centric, cross-sectional, survey of 3,005 adult FSWs was conducted (January–July 2019) on 12 Sex Work (SW) programme sites across nine provinces of South Africa. Sites had existing SW networks and support programmes providing peer education and HIV services. FSWs were involved in the study design, questionnaire development, and data collection. Questions included: demographic, sexual behaviour, HIV testing and treatment/PrEP history, and violence exposure. HIV rapid testing, viral load, CD4 count, HIV recency, and HIV drug resistance genotypic testing were undertaken. Partner organisations provided follow-up services. Results HIV Prevalence was 61.96%, the median length of selling sex was 6 years, and inconsistent condom use was reported by 81.6% of participants, 88.4% reported childhood trauma, 46.2% reported physical or sexual abuse by an intimate partner and 57.4% by a client. More than half of participants had depression and post-traumatic stress disorder (52.7% and 54.1%, respectively). Conclusion This is the first national survey of HIV prevalence amongst FSWs in programmes in South Africa. The data highlight the vulnerability of this population to HIV, violence and mental ill health, suggesting the need for urgent law reform. Based on the unique methodology and the successful implementation alongside study partners, the outcomes will inform tailored interventions. Our rapid rate of enrolment, low rate of screening failure and low proportion of missing data showed the feasibility and importance of community-centric research with marginalised, highly vulnerable populations.
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Affiliation(s)
- Minja Milovanovic
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa.,African Potential Management Consultancy, Kyalami, South Africa
| | - Rachel Jewkes
- Office of the Executive Scientist, South African Medical Research Council, Pretoria, South Africa.,Gender & Health Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Kennedy Otwombe
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Maya Jaffer
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
| | - Kathryn Hopkins
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Khuthadzo Hlongwe
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
| | - Mokgadi Mathaludi
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
| | - Venice Mbowane
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
| | - Glenda Gray
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa.,Office of the President, South African Medical Research Council, Tygerberg, South Africa
| | - Kristin Dunkle
- Gender & Health Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Gillian Hunt
- National Institute of Communicable Diseases (NICD), Johannesburg, South Africa
| | - Alex Welte
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Reshma Kassanjee
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,South African National Department of Science and Innovation - National Research Foundation (DSI-NRF) Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Nevilene Slingers
- Office of AIDS and TB Research, South African Medical Research Council, Pretoria, South Africa
| | - Lieve Vanleeuw
- Office of AIDS and TB Research, South African Medical Research Council, Pretoria, South Africa
| | - Adrian Puren
- National Institute of Communicable Diseases (NICD), Johannesburg, South Africa
| | - Anthony Kinghorn
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
| | - Neil Martinson
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
| | - Fareed Abdullah
- Office of AIDS and TB Research, South African Medical Research Council, Pretoria, South Africa
| | - Jenny Coetzee
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa.,African Potential Management Consultancy, Kyalami, South Africa.,Gender & Health Research Unit, South African Medical Research Council, Tygerberg, South Africa
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12
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Taylor EH, Marson EJ, Elhadi M, Macleod KDM, Yu YC, Davids R, Boden R, Overmeyer RC, Ramakrishnan R, Thomson DA, Coetzee J, Biccard BM. Factors associated with mortality in patients with COVID-19 admitted to intensive care: a systematic review and meta-analysis. Anaesthesia 2021; 76:1224-1232. [PMID: 34189735 PMCID: PMC8444810 DOI: 10.1111/anae.15532] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2021] [Indexed: 01/08/2023]
Abstract
Identification of high-risk patients admitted to intensive care with COVID-19 may inform management strategies. The objective of this meta-analysis was to determine factors associated with mortality among adults with COVID-19 admitted to intensive care by searching databases for studies published between 1 January 2020 and 6 December 2020. Observational studies of COVID-19 adults admitted to critical care were included. Studies of mixed cohorts and intensive care cohorts restricted to a specific patient sub-group were excluded. Dichotomous variables were reported with pooled OR and 95%CI, and continuous variables with pooled standardised mean difference (SMD) and 95%CI. Fifty-eight studies (44,305 patients) were included in the review. Increasing age (SMD 0.65, 95%CI 0.53-0.77); smoking (OR 1.40, 95%CI 1.03-1.90); hypertension (OR 1.54, 95%CI 1.29-1.85); diabetes (OR 1.41, 95%CI 1.22-1.63); cardiovascular disease (OR 1.91, 95%CI 1.52-2.38); respiratory disease (OR 1.75, 95%CI 1.33-2.31); renal disease (OR 2.39, 95%CI 1.68-3.40); and malignancy (OR 1.81, 95%CI 1.30-2.52) were associated with mortality. A higher sequential organ failure assessment score (SMD 0.86, 95%CI 0.63-1.10) and acute physiology and chronic health evaluation-2 score (SMD 0.89, 95%CI 0.65-1.13); a lower PaO2 :FI O2 (SMD -0.44, 95%CI -0.62 to -0.26) and the need for mechanical ventilation at admission (OR 2.53, 95%CI 1.90-3.37) were associated with mortality. Higher white cell counts (SMD 0.37, 95%CI 0.22-0.51); neutrophils (SMD 0.42, 95%CI 0.19-0.64); D-dimers (SMD 0.56, 95%CI 0.43-0.69); ferritin (SMD 0.32, 95%CI 0.19-0.45); lower platelet (SMD -0.22, 95%CI -0.35 to -0.10); and lymphocyte counts (SMD -0.37, 95%CI -0.54 to -0.19) were all associated with mortality. In conclusion, increasing age, pre-existing comorbidities, severity of illness based on validated scoring systems, and the host response to the disease were associated with mortality; while male sex and increasing BMI were not. These factors have prognostic relevance for patients admitted to intensive care with COVID-19.
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Affiliation(s)
- E H Taylor
- Global Surgery Division, University of Cape Town, Cape Town, South Africa
| | - E J Marson
- College of Medical and Dental Sciences, Birmingham, UK
| | - M Elhadi
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | | | - Y C Yu
- Department of Anaesthesiology and Critical Care, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - R Davids
- Department of Anaesthesiology and Critical Care, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - R Boden
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - R C Overmeyer
- Department of Anaesthesiology and Critical Care, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - R Ramakrishnan
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - D A Thomson
- Division of Critical Care, University of Cape Town, Cape Town, South Africa
| | - J Coetzee
- Department of Anaesthesiology and Critical Care, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - B M Biccard
- Department of Anaesthesia and Peri-operative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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13
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Stone J, Mukandavire C, Boily M, Fraser H, Mishra S, Schwartz S, Rao A, Looker KJ, Quaife M, Terris‐Prestholt F, Marr A, Lane T, Coetzee J, Gray G, Otwombe K, Milovanovic M, Hausler H, Young K, Mcingana M, Ncedani M, Puren A, Hunt G, Kose Z, Phaswana‐Mafuya N, Baral S, Vickerman P. Estimating the contribution of key populations towards HIV transmission in South Africa. J Int AIDS Soc 2021; 24:e25650. [PMID: 33533115 PMCID: PMC7855076 DOI: 10.1002/jia2.25650] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/26/2020] [Accepted: 11/12/2020] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION In generalized epidemic settings, there is insufficient understanding of how the unmet HIV prevention and treatment needs of key populations (KPs), such as female sex workers (FSWs) and men who have sex with men (MSM), contribute to HIV transmission. In such settings, it is typically assumed that HIV transmission is driven by the general population. We estimated the contribution of commercial sex, sex between men, and other heterosexual partnerships to HIV transmission in South Africa (SA). METHODS We developed the "Key-Pop Model"; a dynamic transmission model of HIV among FSWs, their clients, MSM, and the broader population in SA. The model was parameterized and calibrated using demographic, behavioural and epidemiological data from national household surveys and KP surveys. We estimated the contribution of commercial sex, sex between men and sex among heterosexual partnerships of different sub-groups to HIV transmission over 2010 to 2019. We also estimated the efficiency (HIV infections averted per person-year of intervention) and prevented fraction (% IA) over 10-years from scaling-up ART (to 81% coverage) in different sub-populations from 2020. RESULTS Sex between FSWs and their paying clients, and between clients with their non-paying partners contributed 6.9% (95% credibility interval 4.5% to 9.3%) and 41.9% (35.1% to 53.2%) of new HIV infections in SA over 2010 to 2019 respectively. Sex between low-risk groups contributed 59.7% (47.6% to 68.5%), sex between men contributed 5.3% (2.3% to 14.1%) and sex between MSM and their female partners contributed 3.7% (1.6% to 9.8%). Going forward, the largest population-level impact on HIV transmission can be achieved from scaling up ART to clients of FSWs (% IA = 18.2% (14.0% to 24.4%) or low-risk individuals (% IA = 20.6% (14.7 to 27.5) over 2020 to 2030), with ART scale-up among KPs being most efficient. CONCLUSIONS Clients of FSWs play a fundamental role in HIV transmission in SA. Addressing the HIV prevention and treatment needs of KPs in generalized HIV epidemics is central to a comprehensive HIV response.
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Affiliation(s)
- Jack Stone
- Population Health SciencesUniversity of BristolBristolUnited Kingdom
| | - Christinah Mukandavire
- Department of Infectious Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | - Marie‐Claude Boily
- Department of Infectious Disease EpidemiologyImperial CollegeLondonUnited Kingdom
| | - Hannah Fraser
- Population Health SciencesUniversity of BristolBristolUnited Kingdom
| | | | - Sheree Schwartz
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Amrita Rao
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | | | - Matthew Quaife
- London School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | | | - Alexander Marr
- University of California San FranciscoSan FranciscoCAUSA
| | - Tim Lane
- Equal InternationalWashingtonDCUSA
| | - Jenny Coetzee
- Perinatal HIV Research UnitFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- South African Medical Research CouncilCape TownSouth Africa
| | - Glenda Gray
- South African Medical Research CouncilCape TownSouth Africa
| | - Kennedy Otwombe
- Perinatal HIV Research UnitFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Minja Milovanovic
- Perinatal HIV Research UnitFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | | | | | | | | | - Adrian Puren
- National Institute of Communicable DiseasesJohannesburgSouth Africa
| | - Gillian Hunt
- National Institute of Communicable DiseasesJohannesburgSouth Africa
| | - Zamakayise Kose
- Research and Innovation OfficeNorth West UniversityPotchefstroomSouth Africa
| | | | - Stefan Baral
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Peter Vickerman
- Population Health SciencesUniversity of BristolBristolUnited Kingdom
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14
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Taylor EH, Hofmeyr R, Torborg A, van Tonder C, Boden R, Earle E, Nejthardt M, Kabambi KF, Isaacs M, Usenbo A, Gerber C, van der Spuy K, Mrara B, Ndhlovu T, Chen A, Swanevelder J, Coetzee J, Biccard BM. Risk factors and interventions associated with mortality or survival in adult COVID-19 patients admitted to critical care: a systematic review and meta-analysis. South Afr J Anaesth Analg 2020. [DOI: 10.36303/sajaa.2020.26.3.2428] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Patients with confirmed COVID-19 admitted to intensive care units have a high mortality rate, which appears to be associated with increasing age, male sex, smoking history, hypertension and diabetes mellitus.
Methods: A systematic review to determine risk factors and interventions associated with mortality/survival in adult patients admitted to an intensive care unit (ICU) with confirmed COVID-19/SARS-CoV-2 infection. The protocol was registered with PROSPERO (CRD42020181185).
Results: The search identified 483 abstracts between 1 January and 7 April 2020, of which nine studies were included in the final review. Only one study was of low bias. Advanced age (odds ratio [OR] 11.99, 95% confidence interval [CI] 5.35–18.62) and a history of hypertension were associated with mortality (OR 4.17, 95% CI 2.90–5.99). Sex was not associated with mortality. There was insufficient data to assess the association between other comorbidities, laboratory results or critical care risk indices and mortality. The critical care interventions of mechanical ventilation (OR 6.25, 95% CI 0.75–51.93), prone positioning during ventilation (OR 2.06, 95% CI 0.20–21.72), and extracorporeal membrane oxygenation (ECMO) (OR 8.00, 95% CI 0.69, 92.33) were not associated with mortality. The sample size was insufficient to conclusively determine the association between these interventions and ICU mortality. The need for inotropes or vasopressors was associated with mortality (OR 6.36, 95% CI 1.89–21.36).
Conclusion: The studies provided little granular data to inform risk stratification or prognostication of patients requiring intensive care admission. Larger collaborative research is needed to address this limitation.
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Affiliation(s)
| | | | | | | | | | - E Earle
- University of the Free State
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15
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Huschke S, Coetzee J. Sex work and condom use in Soweto, South Africa: a call for community-based interventions with clients. Cult Health Sex 2020; 22:1-15. [PMID: 30794091 DOI: 10.1080/13691058.2019.1568575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 01/08/2019] [Indexed: 05/22/2023]
Abstract
Despite public health interventions targeting sex workers in an attempt to increase condom use, HIV still remains a significant health issue for those involved in the sex industry in many countries. In this paper, we analyse data collected as part of an ethnographic study of sex work in Soweto, South Africa. We show that the main problems with consistent condom use are clients who threaten violence if sex workers insist on condoms, clients who are 'rough' and refuse to stop intercourse when the condom breaks, and clients who offer to pay more money for unprotected sex. These issues relate to unequal gender norms that disempower female sex workers and dismiss the importance of consent in sexual relationships. The criminalisation of sex work increases vulnerability and reduces sex workers' agency as sex workers are reluctant to report crimes committed against them. Persistent 'whore stigma' adds to this dynamic by dehumanising sex workers. In conclusion, we advocate for decriminalisation and posit that public health interventions aimed at increasing condom use and reducing HIV rates need to specifically engage clients, address unequal gender norms and involve local communities to tackle stigma directed against sex workers.
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Affiliation(s)
- Susann Huschke
- African Centre for Migration & Society and School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Jenny Coetzee
- Perinatal HIV Research Unit, New Nurses Home, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
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16
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Fourie T, Schellack N, Bronkhorst E, Coetzee J, Godman B. Antibiotic prescribing practices in the presence of extended-spectrum β-lactamase (ESBL) positive organisms in an adult intensive care unit in South Africa – A pilot study. Alexandria Journal of Medicine 2019. [DOI: 10.1016/j.ajme.2018.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- T. Fourie
- Mediclinic Tzaneen, 24 Douglas Ave, Tzaneen, 0850, South Africa
| | - N. Schellack
- Department of Pharmacy, Faculty of Health Sciences, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
| | - E. Bronkhorst
- Department of Pharmacy, Faculty of Health Sciences, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
| | - J. Coetzee
- Ampath National Reference Laboratory, Pretoria, South Africa
| | - B. Godman
- Department of Pharmacy, Faculty of Health Sciences, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
- Division of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Health Economics Centre, Liverpool University Management School, Liverpool, United Kingdom
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17
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Parsons R, Dewell G, Dewell R, Coetzee J, Noffsinger T, Johnson A, Millman S. PSIX-34 Acclimating feedlot cattle: Effects on home pen behavior. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- R Parsons
- Iowa State University,Ames, IA, United States
| | - G Dewell
- Iowa State University,Ames, IA, United States
| | - R Dewell
- Iowa State University,Ames, IA, United States
| | - J Coetzee
- Kansas State University,Manhattan, KS, United States
| | - T Noffsinger
- Production Animal Consultation,Oakley, KS, United States
| | - A Johnson
- Iowa State University,Ames, IA, United States
| | - S Millman
- Iowa State University,Ames, IA, United States
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Marti S, Janzen E, Pajor E, Orsel K, Jelinski M, Dorin C, Thomson D, Coetzee J, Shearer J, Millman S, Schwartzkopf-Genswein K. 228 Relationship between biomarkers of stress, inflammation and pain, and lameness in feedlot cattle. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Marti
- IRTA-Institut de Recerca i Tecnologia Agroalimentaries,Caldes de Montbui, CA, Spain
| | - E Janzen
- University of Calgary,Calgary, AB, Canada
| | - E Pajor
- University of Calgary,Calgary, AB, Canada
| | - K Orsel
- Faculty of Veterinary Medicine, University of Calgary,Calgary, AB, Canada
| | - M Jelinski
- Veterinary Agri-Health Services Ltd,Airdrie, AB, Canada
| | - C Dorin
- Veterinary Agri-Health Services Ltd,Airdrie, AB, Canada
| | - D Thomson
- Kansas State University,Manhattan, KS, United States
| | - J Coetzee
- Kansas State University,Manhattan, KS, United States
| | - J Shearer
- Iowa State University,Ames, IA, United States
| | - S Millman
- Iowa State University,Ames, IA, United States
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Coetzee J, Gray GE, Jewkes R. Prevalence and patterns of victimization and polyvictimization among female sex workers in Soweto, a South African township: a cross-sectional, respondent-driven sampling study. Glob Health Action 2018; 10:1403815. [PMID: 29211633 PMCID: PMC5727426 DOI: 10.1080/16549716.2017.1403815] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Female sex workers (FSWs) are disproportionately affected by violence from multiple partner categories. This increases their vulnerability to HIV. Objectives: To describe patterns of violence and polyvictimization among female SWs in Soweto. Methods: A respondent-driven sampling (RDS) recruitment methodology was used to enrol 508 Soweto-based FSWs using a survey instrument. Raw and RDS adjusted data were descriptively analysed, Spearman’s correlation and chi2 test of association were used to show associations. Polyvictimization patterns are shown within a modified Venn diagram. Results: The median age of FSWs in Soweto was 31 years, and most had an incomplete education (74.2%). The prevalence of exposure to physical/sexual intimate partner violence (IPV) in the past year was 53.8%, 46.8% by clients, and 18.5% by police. Past year prevalence of sexual/physical violence by any perpetrator category was 70.8% and lifetime exposure was 76.0%. Childhood sexual violence was reported by 44.3%. Lifetime non-partner rape was 55.5% and all rape exposure was 62.4%. As a result of engaging in sex work in the past year, 65.2% women had been discriminated against. Client, police, IPV, and childhood trauma were all significantly associated with one another, with IPV being the most common co-occurrence. Polyvictimization was seen in almost two-thirds of FSWs, and increased with exposure to discrimination. Conclusion: In Soweto, FSWs are exposed to high rates of violence in multiple forms across their lifetime. Our findings show that violence continues unabated into adulthood at levels far higher than in the general population and overall at higher levels than previously recorded among SWs in South Africa. We argue that violence against FSWs is rooted in discrimination. The disparate burden of violence on FSWs requires urgent interventions to proactively address and reframe the normalisation of violence against all women.
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Affiliation(s)
- J Coetzee
- a Perinatal HIV Research Unit , University of the Witwatersrand, Chris Hani Baragwanath Hospital , Johannesburg , South Africa.,b Department of Public Health , University of the Witwatersrand , Johannesburg , South Africa
| | - G E Gray
- a Perinatal HIV Research Unit , University of the Witwatersrand, Chris Hani Baragwanath Hospital , Johannesburg , South Africa.,c Office of the President , South African Medical Research Council , Cape Town , South Africa
| | - R Jewkes
- b Department of Public Health , University of the Witwatersrand , Johannesburg , South Africa.,c Office of the President , South African Medical Research Council , Cape Town , South Africa
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Coetzee J, Buckley J, Otwombe K, Milovanovic M, Gray GE, Jewkes R. Depression and Post Traumatic Stress amongst female sex workers in Soweto, South Africa: A cross sectional, respondent driven sample. PLoS One 2018; 13:e0196759. [PMID: 29975685 PMCID: PMC6033380 DOI: 10.1371/journal.pone.0196759] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 04/19/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sex workers in South Africa are exposed to high levels of violence, yet little is known about their mental health needs. This study aims to understanding the prevalence of depression and post-traumatic stress disorder (PTSD) and their risk factors amongst female sex worker (FSWs) in Soweto, South Africa. METHODS A cross-sectional, respondent-driven sampling (RDS) survey enrolled 508 FSWs. Raw and RDS adjusted data were analyzed using a chi-squared test of association and multinomial regression for risk factors associated with depression and PTSD. FINDINGS Symptoms of severe depression were prevalent amongst 68.7%, PTSD was 39.6%, and 32.7% suffered from comorbid PTSD and depression. Experiencing ≥3 kinds of violence increased the likelihood of comorbidity (RRR4.11, 95% CI 1.52-11.12,p = 0.005). Internalised stigma increased the likelihood of one mental health condition (RRR1.25, 95% CI 1.10-1.42,p = 0.001), higher self-esteem was associated with independent (RRR1.14, 95% CI 1.05-1.25,p = 0.002) and comorbid conditions (RRR1.17, 95% CI 1.07-1.27,p = 0.001). CONCLUSION Our findings highlight the sizable burden of treatable mental health conditions among FSWs in Soweto. This was driven by multiple exposures to violence, sex work related discrimination and overall moderate levels of self-esteem masking defence mechanisms. This suggests the urgent need to design and integrate services geared to the mental health needs for this population.
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Affiliation(s)
- Jenny Coetzee
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Janice Buckley
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
- Department of Psychiatry, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | - Kennedy Otwombe
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Minja Milovanovic
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Glenda E. Gray
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
- Office of the President, South African Medical Research Council, Cape Town, South Africa
| | - Rachel Jewkes
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Office of the President, South African Medical Research Council, Cape Town, South Africa
- Gender & Health Research Unit, South African Medical Research Council, Pretoria, South Africa
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Canning P, Bates J, Skoland K, Coetzee J, Wulf L, Rajewski S, Wang C, Gauger P, Ramirez A, Karriker L. Variation in water disappearance, daily dose, and synovial fluid concentrations of tylvalosin and 3-O-acetyltylosin in commerical pigs during five day water medication with tylvalosin under field conditions. J Vet Pharmacol Ther 2018; 41:632-636. [PMID: 29572923 DOI: 10.1111/jvp.12503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 02/25/2018] [Indexed: 11/29/2022]
Abstract
Tylvalosin (TVN) is a water soluble macrolide used in swine production to treat enteric, respiratory, and arthritic pathogens. There is limited data on its distribution to synovial fluid beyond gavage studies, which do not represent field conditions. This study measured water disappearance, TVN concentration in the medicated water, daily dose, and concentrations of TVN and 3-O-acetyltylosin (3AT) in the synovial fluid and plasma of treated pigs over the administration period. The study emphasized understanding variation in tissue TVN concentrations within the context of a field setting. Sixty finisher pigs were housed individually with individual waterers. Six pigs were randomly allocated to the following time points for sample collection: 0, 48, 60, 72, 84, 96, 102, 108, 114, and 120 hr on medication. TVN was administered daily in the water for 5 days. Water disappearance and medicated water concentration were measured daily. At each time point, six pigs were euthanized and plasma and synovial fluid were collected for analysis. Median TVN synovial fluid concentrations ranged between <1 ng/ml (hour 0) to 3.6 ng/ml (hour 84). There was substantial variation between individual pigs for water disappearance (mean 4.36L and range 0-7.84). Median TVN water concentration was 59 ppm (range 38-75 ppm).
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Affiliation(s)
- P Canning
- Swine Medicine Education Center, College of Veterinary Medicine, Iowa State University, Ames, IA, USA
| | - J Bates
- RTI, LLC, Brookings, SD, USA
| | - K Skoland
- Swine Medicine Education Center, College of Veterinary Medicine, Iowa State University, Ames, IA, USA
| | - J Coetzee
- Department of Anatomy & Physiology, College of Veterinary Medicine, Kansas State University, Manhattan, KS, USA
| | - L Wulf
- Pharmacology Analytical Support Team, Veterinary Clinical Sciences, Iowa State University, Ames, IA, USA
| | - S Rajewski
- Pharmacology Analytical Support Team, Veterinary Clinical Sciences, Iowa State University, Ames, IA, USA
| | - C Wang
- Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA, USA
| | - P Gauger
- Veterinary Diagnostic Laboratory, Iowa State University, Ames, IA, USA
| | - A Ramirez
- Swine Medicine Education Center, College of Veterinary Medicine, Iowa State University, Ames, IA, USA
| | - L Karriker
- Swine Medicine Education Center, College of Veterinary Medicine, Iowa State University, Ames, IA, USA
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Mulaudzi M, Dlamini BN, Coetzee J, Sikkema K, Gray G, Dietrich JJ. Perceptions of counsellors and youth-serving professionals about sexual and reproductive health services for adolescents in Soweto, South Africa. Reprod Health 2018; 15:21. [PMID: 29409503 PMCID: PMC5801675 DOI: 10.1186/s12978-018-0455-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 01/07/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Adolescents in South Africa remain vulnerable to HIV. Therefore, it is crucial to provide accessible adolescent-friendly HIV prevention interventions that are sensitive to their needs. This study aimed to investigate the perceptions of HIV counsellors and other youth-serving professionals about the barriers to providing adolescent youth-friendly sexual and reproductive health services to adolescents in Soweto, South Africa. The study also explored how sexual and reproductive health services in South Africa could be improved to become more accessible to adolescents. METHODS The research team conducted two focus group discussions with HIV counsellors, and 19 semi-structured interviews with youth-serving professionals from organisations working with adolescents. Audio-recorded data were transcribed verbatim and analysed using thematic analysis. RESULTS The results of the study reveal that counsellors were expected to give adolescents HIV counselling and testing (HCT) but felt restricted by what they perceived as inflexible standard operating procedures. Counsellors reported inadequate training to address adolescent psychosocial issues during HCT. Healthcare provider attitudes were perceived as a barrier to adolescents using sexual and reproductive health services. Participants strongly recommended augmenting adolescent sexual and reproductive health services to include counsellors and adolescents in developing age- and context-specific HIV prevention services for adolescents. CONCLUSION Continuous upskilling of HIV counsellors is a critical step in providing adolescent-friendly services. Input from all relevant stakeholders, including counsellors and adolescents, is essential in designing adolescent-friendly services.
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Affiliation(s)
- Mamakiri Mulaudzi
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Road, Diepkloof, Soweto, Johannesburg, 1864 South Africa
| | - Busisiwe Nkala Dlamini
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Road, Diepkloof, Soweto, Johannesburg, 1864 South Africa
| | - Jenny Coetzee
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Road, Diepkloof, Soweto, Johannesburg, 1864 South Africa
| | - Kathleen Sikkema
- Duke University, Department of Psychology and Neuroscience, Durham, USA
| | - Glenda Gray
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Road, Diepkloof, Soweto, Johannesburg, 1864 South Africa
- South African Medical Research Council, Cape Town, South Africa
| | - Janan Janine Dietrich
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Road, Diepkloof, Soweto, Johannesburg, 1864 South Africa
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Coetzee J, Hunt G, Jaffer M, Otwombe K, Scott L, Bongwe A, Ledwaba J, Molema S, Jewkes R, Gray GE. HIV-1 viraemia and drug resistance amongst female sex workers in Soweto, South Africa: A cross sectional study. PLoS One 2017; 12:e0188606. [PMID: 29244809 PMCID: PMC5731765 DOI: 10.1371/journal.pone.0188606] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 11/09/2017] [Indexed: 12/25/2022] Open
Abstract
Background HIV drug resistance (HIVDR) poses a threat to future antiretroviral therapy success. Monitoring HIVDR patterns is of particular importance in populations such as sex workers (SWs), where documented HIV prevalence is between 34–89%, and in countries with limited therapeutic options. Currently in South Africa, there is a dearth in evidence and no ongoing surveillance of HIVDR amongst sex work populations. This study aims to describe the prevalence of HIVDR amongst a sample of female sex workers (FSWs) from Soweto, South Africa. Methodology A cross-sectional, respondent driven sampling (RDS) recruitment methodology was used to enrol FSWs based in Soweto. Participants were tested for HIV and undertook a survey that included HIV knowledge and treatment status. Whole blood specimens were collected from HIV positive FSWs to measure for CD4 counts, viral load (VL) and perform HIVDR genotyping. Frequencies were determined for categorical variables and medians and interquartile ranges (IQR) for the continuous. Results Of the 508 enrolled participants, 55% (n = 280) were HIV positive and of median age 32 (IQR: 20–51) years. Among the HIV positive, 51.8% (132/269) were defined as virologically suppressed (VL < 400 copies/ml). Of the 119 individuals with unsuppressed viral loads who were successfully genotyped for resistance testing 37.8% (45/119) had detectable drug resistance. In this group, HIVDR mutations were found amongst 73.7% (14/19) of individuals on treatment, 27.4% (26/95) of individuals who were treatment naïve, and 100% (5/5) of defaulters. One phylogenetic cluster was found amongst treatment naïve FSWs. The K103N mutation was detected most commonly in 68.9% (31/45) individuals with HIVDR mutations, with 20/26 (76.9%) of treatment naïve FSW with detectable resistance having this mutation. The M184V mutation was found in both FSWs on treatment (12/14, 85.7%) and those defaulting (1/5, 20.0%). Discussion More than one third (45/119) of the genotyped sample had HIVDR, with resistance to the NNRTI class being the most common. Almost half of HIV positive FSWs had unsuppressed viral loads, increasing the likelihood for onward transmission of HIV. Disturbingly, more than 1:4 treatment naïve women with unsuppressed viral loads had HIVDR suggesting that possible sexual transmission of drug resistance is occurring in this high-risk population. Given the high burden of HIVDR in a population with a high background prevalence of HIV, it is imperative that routine monitoring of HIVDR be implemented. Understanding transmission dynamics of HIVDR in FSW and its impact on treatment success should be urgently elucidated.
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Affiliation(s)
- Jenny Coetzee
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Gillian Hunt
- National Institute for Communicable Diseases (NICD), Sandringham, South Africa
| | - Maya Jaffer
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kennedy Otwombe
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lesley Scott
- Department of Molecular Medicine and Haematology, Faculty of Health Science, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Asiashu Bongwe
- National Institute for Communicable Diseases (NICD), Sandringham, South Africa
| | - Johanna Ledwaba
- National Institute for Communicable Diseases (NICD), Sandringham, South Africa
| | - Sephonono Molema
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rachel Jewkes
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Glenda E. Gray
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Office of the President, South African Medical Research Council, Cape Town, South Africa
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Mukudu H, Martinson N, Sartorius B, Coetzee J, Dietrich J, Mokgatswana K, Jewkes R, Gray GE, Dugas M, Béhanzin L, Guédou FA, Gagnon MP, Alary M, Rutakumwa R, Mbonye M, Kiwanuka T, Nakamanya S, Muhumuza R, Nalukenge W, Seeley J, Atujuna M, Wallace M, Brown B, Bekker LG, Newman PA, Harryparsad R, Olivier AJ, Jaspan HB, Wilson D, Dietrich J, Martinson N, Mukudu H, Mkhize N, Morris L, Cianci G, Dinh M, Hope T, Passmore JAS, Gray CM, Henrick BM, Yao XD, Rosenthal KL, Henrick BM, Yao XD, Drannik AG, Abimiku A, Rosenthal KL, Chanzu N, Mwanda W, Oyugi J, Anzala O, Mbow M, Jallow S, Thiam M, Davis A, Diouf A, Ndour CT, Seydi M, Dieye TN, Mboup S, Goodier M, Rilley E, Jaye A, Yao XD, Omange RW, Henrick BM, Lester RT, Kimani J, Ball TB, Plummer FA, Rosenthal KL, Béhanzin L, Guédou FA, Geraldo N, Mastétsé EG, Sossa JC, Zannou MD, Alary M, Osawe S, Okpokoro E, Okolo F, Umaru S, Abimiku R, Audu S, Datong P, Abimiku A, Nyange J, Olenja J, Mutua G, Jaoko W, Omosa-Manyonyi G, Farah B, Khaniri M, Anzala O, Cockcroft A, Tonkin K, Girish I, Mhati P, Cunningham A, Andersson N, Farah B, Indangasi J, Jaoko W, Mutua G, Khaniri M, Nyange J, Anzala O, Diphoko T, Gaseitsiwe S, Maiswe V, Iketleng T, Maruapula D, Bedi K, Moyo S, Musonda R, Wainberg M, Makhema J, Novitsky V, Marlink R, Essex M, Okoboi S, Ssali L, Kalibala S, Birungi J, Egessa A, Wangisi J, Okullu LJ, Bakanda C, Obare F, Boer IMSD, Semvua HH, van den Boogaard J, Kiwango KW, Ngowi KM, Nieuwkerk PT, Aarnoutse RE, Kiwelu I, Muro E, Kibiki GS, Datiri R, Choji G, Osawe S, Okpokoro E, Okolo F, Umaru S, Abimiku R, Audu S, Datong P, Abimiku A, Fomsgaard A, Karlsson I, Jensen KJ, Jensen SS, Leo-Hansen C, Jespersen S, Da Silva Té D, Rodrigues CM, da Silva ZJ, Janitzek CM, Gerstoft J, Kronborg G, Okpokoro E, Osawe S, Daitiri R, Choji G, Umaru S, Okolo F, Datong P, Abimiku A, Emily N, Joyce O, Robert LR, Anzala A, Viljoen K, Wendoh J, Kidzeru E, Karaoz U, Brodie E, Botha G, Mulder N, Gray C, Cameron W, Stintzi A, Jaspan H, Levett PN, Alexander D, Gulzar N, Grewal PS, Poon AFY, Brumme Z, Harrigan PR, Brooks JI, Sandstrom PA, Calvez S, Sanche SE, Scott JK, Swartz L, Kagee A, Lesch A, Kafaar Z, De Wet A, Okpokoro E, Osawe S, Daitiri R, Choji G, Umaru S, Okolo F, Datong P, Abimiku A, Dietrich J, Smith T, Cotton L, Hornschuh S, van der Watt M, Miller CL, Gray G, Smit J, Jaggernath M, Ndung’u T, Brockman M, Kaida A, Akolo M, Kimani J, Gelmon L, Chitwa M, Osero J, Cockcroft A, Marokoane N, Kgakole L, Maswabi B, Mpofu N, Ansari U, Andersson N, Nakinobe E, Miiro GM, Zalwango F, Nakiyingi-Miiro J, Kaleebu P, Semwanga JR, Nyanzi E, Musoke SN, Nakinobe E, Miiro G, Mbidde EK, Lutalo T, Kaleebu P, Handema R, Chianzu GP, Thiam M, Diagne-Gueye D, Ndiaye MK, Mbow M, Ndiaye BP, Traore I, Dia MC, Thomas G, Tour-Kane C, Mboup S, Jaye A, Nyanzi E, Mbidde EK, Kaleebu P, Mpendo J, Kimani J, Birungi J, Muyindike W, Kambugu A, Sebastian H, Ray H, Mike C, Bertin KJ, Modest M, Thiam M, Janha O, Davis A, Amambua-Ngwa A, Nwakanma DC, Mboup S, Jaye A, Jespersen S, Hønge BL, Esbjörnsson J, Medina C, Da Silva TÉ D, Correira FG, Laursen AL, Østergaard L, Andersen A, Aaby P, Erikstrup C, Wejse C, Dieye S, Sarr M, Sy H, Mbodj HD, Ndiaye M, Ndiaye A, Moussa S, Jaye A, Mboup S, Nyombi BM, Shao ER, Chilumba IB, Moyo S, Gaseitsiwe S, Musonda R, Datong P, Inyang B, Osawe S, Izang A, Cole C, Okolo F, Cameron B, Rosenthal K, Gray C, Jaspan H, Abimiku A, Seraise B, Andrea-Marobela K, Moyo S, Musonda R, Makhema J, Essex M, Gaseitsiwe S. Afri-Can Forum 2. BMC Infect Dis 2016; 16 Suppl 2:315. [PMID: 27410689 PMCID: PMC4943497 DOI: 10.1186/s12879-016-1466-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
A1 Introduction to the 2nd synchronicity forum of GHRI/CHVI-funded Canadian and African HIV prevention and vaccine teams O1 Voluntary medical male circumcision for prevention of heterosexual transmission of HIV in adult males in Soweto: What do indicators and incidence rate show? Hillary Mukudu, Neil Martinson, Benn Sartorius O2 Developing a peer-led community mobilization program for sex workers in Soweto: HIV risk and demographics Jenny Coetzee, Janan Dietrich, Kgaugelo Mokgatswana, Rachel Jewkes, Glenda E. Gray O3 Salient beliefs about adherence: A qualitative survey conducted as part of the demonstration study on "treatment as prevention" (TasP) and "pre-exposure prophylaxis" (PrEP) among female sex workers (FSWS) in Cotonou, Benin Marylène Dugas, Luc Béhanzin, Fernand A. Guédou, Marie-Pierre Gagnon, Michel Alary O4 Relative perception of risk as a driver of unsafe sexual practices among key populations: Cases of fisherfolk and women and their partners involved in multiple sexual partnerships in Uganda Rwamahe Rutakumwa, Martin Mbonye, Thadeus Kiwanuka, Sarah Nakamanya, Richard Muhumuza, Winfred Nalukenge, Janet Seeley O5 Exploring the acceptability of new biomedical HIV prevention technologies among MSM, adolescents and heterosexual adults in South Africa Millicent Atujuna, Melissa Wallace, Ben Brown, Linda Gail Bekker, Peter A. Newman O6 HIV-susceptible target cells in foreskins after voluntary medical male circumcision in South Africa Rushil Harryparsad, Abraham J. Olivier, Heather B. Jaspan, Douglas Wilson, Janan Dietrich, Neil Martinson, Hillary Mukudu, Nonhlanhla Mkhize, Lynn Morris, Gianguido Cianci, Minh Dinh, Thomas Hope, Jo-Ann S. Passmore, Clive M. Gray O7 HIV-1 proteins activate innate immune responses via TLR2 heterodimers Bethany M. Henrick, Xiao-Dan Yao, Kenneth L. Rosenthal, the INFANT Study Team O8 Characterization of an innate factor in human milk and mechanisms of action against HIV-1 Bethany M. Henrick, Xiao-Dan Yao, Anna G. Drannik, Alash’le Abimiku, Kenneth L. Rosenthal, the INFANT Study Team O9 Secretor status and susceptibility to HIV infections among female sex workers in Nairobi, Kenya Nadia Chanzu, Walter Mwanda, Julius Oyugi, Omu Anzala O10 Natural Killer cell recall responsiveness to Gag-HIV-1 peptides of HIV-1 exposed but uninfected subjects are associated with peripheral CXCR6+ NK cell subsets Moustapha Mbow, Sabelle Jallow, Moussa Thiam, Alberta Davis, Assane Diouf, Cheikh T. Ndour, Moussa Seydi, Tandakha N. Dieye, Souleymane Mboup, Martin Goodier, Eleanor Rilley, Assan Jaye O11 Profiles of resistance: Local innate mucosal immunity to HIV-1 in commercial sex workers Xiao-Dan Yao, RW. Omange, Bethany M. Henrick, Richard T. Lester, Joshua Kimani, T. Blake Ball, Francis A. Plummer, Kenneth L. Rosenthal O12 Early antiretroviral therapy and pre-exposure prophylaxis for HIV prevention among female sex workers in Cotonou, Benin: A demonstration project Luc Béhanzin, Fernand A. Guédou, Nassirou Geraldo, Ella Goma Mastétsé, Jerôme Charles Sossa, Marcel Djimon Zannou, Michel Alary O13 Building capacity for HIV prevention trials: Preliminary data from a Nigerian cohort of HIV exposed sero-negatives (HESN) Sophia Osawe, Evaezi Okpokoro, Felicia Okolo, Stephen Umaru, Rebecca Abimiku, Sam Audu, Pam Datong, Alash’le Abimiku O14 Equipping healthcare professionals with skills required for the conduct of clinical trials in an effort to build capacity. Lessons learned Jacquelyn Nyange, Joyce Olenja, Gaudensia Mutua, Walter Jaoko, Gloria Omosa-Manyonyi, Bashir Farah, Maureen Khaniri, Omu Anzala O15 Educational technology to support active learning for HIV researchers and planners Anne Cockcroft, Kendra Tonkin, Indu Girish, Puna Mhati, Ashley Cunningham, Neil Andersson O16 From Lake Kivu (Rwanda) and Lake Malawi (Tanzania) to the shores of Lake Victoria (Uganda): Strengthening laboratory capacity through Good Clinical Laboratory Practice training Bashir Farah, Jackton Indangasi, Walter Jaoko, Gaudensia Mutua, Maureen Khaniri, Jacquelyn Nyange, Omu Anzala O17 Rilpivirine and etravirine resistance mutations in HIV-1 subtype C infected patients on a non-nucleoside reverse transcriptase inhibitor-based combination antiretroviral therapy in Botswana Thabo Diphoko, Simani Gaseitsiwe, Victoria Maiswe, Thato Iketleng, Dorcas Maruapula, Keabetswe Bedi, Sikhulile Moyo, Rosemary Musonda, Mark Wainberg, Joseph Makhema, Vladimir Novitsky, Richard Marlink, Max Essex O18 From home-based HIV testing to initiation of treatment: The AIDS Support Organization (TASO) Experience with Home-based HIV Counselling and Testing (HBHCT) among Adolescents in Uganda, 2005-2011 Stephen Okoboi, Livingstone Ssali, Sam Kalibala, Josephine Birungi, Aggrey Egessa, Jonathan Wangisi, Lyavala Joanne Okullu, Celestin Bakanda, Francis Obare41 O19 Feasibility study on using real time medication monitoring among HIV infected and Tuberculosis patients in Kilimanjaro, Tanzania I. Marion Sumari-de Boer, Hadija H. Semvua, Jossy van den Boogaard, Krisanta W. Kiwango, Kennedy M. Ngowi, Pythia T. Nieuwkerk, Rob E. Aarnoutse, Ireen Kiwelu, Eva Muro, Gibson S. Kibiki O20 Deaths still among sero-discordant cohort in Nigeria despite Access to treatment Ruth Datiri, Grace Choji, Sophia Osawe, Evaezi Okpokoro, Felicia Okolo, Stephen Umaru, Rebecca Abimiku, Samuel Audu, Pam Datong, Alash’le Abimiku O21 Therapeutic HIV-1 vaccine trials in Denmark and Guinea-Bissau Fomsgaard A, Karlsson I, Jensen KJ, Jensen SS, Leo-Hansen C, Jespersen S, Da Silva Té D, Rodrigues CM, da Silva ZJ, Janitzek CM, Gerstoft J, Kronborg G, the WAPHIR Group O22 Willingness to participate in a HIV vaccine Trial among HIV exposed sero-negative (HESN) persons in Jos, Nigeria Evaezi Okpokoro, Sophia Osawe, Ruth Daitiri, Grace Choji, Stephen Umaru, Felicia Okolo, Pam Datong, Alash'le Abimiku O23 Clinical research volunteers’ perceptions and experiences of screening for enrolment at KAVI-Institute of Clinical Research, Kenya Nyariki Emily, Olenja Joyce, Lorway R. Robert, Anzala Anzala O24 Gut microbiome, HIV-exposure, and vaccine responses in South African infants Katie Viljoen, Jerome Wendoh, Elvis Kidzeru, Ulas Karaoz, Eoin Brodie, Gerrit Botha, Nicola Mulder, Clive Gray, William Cameron, Alain Stintzi, Heather Jaspan, for the INFANT study team O25 Analysis of HIV pol diversity in the concentrated HIV epidemic in Saskatchewan Paul N. Levett, David Alexander, Naveed Gulzar, Prabvir S. Grewal, Art F. Y. Poon, Zabrina Brumme, P. Richard Harrigan, James I. Brooks, Paul A. Sandstrom, Stryker Calvez, Stephen E. Sanche, Jamie K. Scott P1 Evaluating a HIV vaccine research community engagement programme at two HIV prevention research centres in the Western Cape Leslie Swartz, Ashraf Kagee, Anthea Lesch, Zuhayr Kafaar, Anneliese De Wet P2 Validating HIV acquisition risk score using a cohort HIV exposed sero-negative persons in a discordant relationship in Jos, Nigeria, West Africa Evaezi Okpokoro, Sophia Osawe, Ruth Daitiri, Grace Choji, Stephen Umaru, Felicia Okolo, Pam Datong, Alash'le Abimiku P3 Bridging the gap between adults and adolescents and youth adults (AYA) – Employing a youth-centred approach to investigate HIV risk among AYA in Soweto and Durban, South Africa Janan Dietrich, Tricia Smith, Laura Cotton, Stefanie Hornschuh, Martin van der Watt, Cari L. Miller, Glenda Gray, Jenni Smit, Manjeetha Jaggernath, Thumbi Ndung’u, Mark Brockman, Angela Kaida, on behalf of the AYAZAZI study teams P4 Neighbours to sex workers: A key population that has been ignored Maureen Akolo, Joshua Kimani, Prof Larry Gelmon, Michael Chitwa, Justus Osero P5 Young women’s access to structural support programmes in a district of Botswana Anne Cockcroft, Nobantu Marokoane, Leagajang Kgakole, Boikhutso Maswabi, Neo Mpofu, Umaira Ansari, Neil Andersson P6 Voices for action from peri-urban Ugandan students, teachers and parents on HIV/STI prevention: Qualitative research results Nakinobe Elizabeth, Miiro George Mukalazi, Zalwango Flavia, Nakiyingi-Miiro Jessica, Kaleebu Potiano P7 Engaging Social Media as an education tool on the fly: The use of Facebook for HIV and Ebola prevention and awareness amongst adolescents in Uganda John Ross Semwanga, Emily Nyanzi, Saidat Namuli Musoke, Elizabeth Nakinobe, George Miiro, Edward Katongole Mbidde, Tom Lutalo, Pontiano Kaleebu P8 Circulating HIV-1 subtypes among sexual minority populations in Zambia Ray Handema, Graham P. Chianzu P9 The Development of HIV Bio-bank resource management to support clinical trial and Intervention research: WAPHIR experience Moussa Thiam, Diabou Diagne-Gueye, Mame K. Ndiaye, Moustapha Mbow, Birahim P. Ndiaye, Ibrahima Traore, Mamadou C. Dia, Gilleh Thomas, Coumba Tour-Kane, Souleymane Mboup, Assan Jaye P10 Capacity building for clinical trials as a novel approach for scaling up HIV prevention research initiatives in East Africa: achievements and challenges Emily Nyanzi, Edward Katongole Mbidde, Pontiano Kaleebu, Juliet Mpendo, Joshua Kimani, Josephine Birungi, Winnie Muyindike, Andrew Kambugu P11 Community and media perspective of research; an advocacy workshop on HIV prevention research Hachizovu Sebastian, Handema Ray, Chaponda Mike, Kabuya Jean Bertin, Mulenga Modest P12 Development of a quantitative HIV-1 and HIV-2 real time PCR (qRT-PCR) viral load assay Moussa Thiam, Omar Janha, Alberta Davis, Alfred Amambua-Ngwa, Davis C. Nwakanma, Souleymane Mboup, Assan Jaye P13 Differential effects of sex in a West African Cohort of HIV-1, HIV-2 and HIV-1/2 dual infected patients: Men are worse off Sanne Jespersen, Bo Langhoff Hønge, Joakim Esbjörnsson, Candida Medina, David Da Silva TÉ, Faustino Gomes Correira, Alex Lund Laursen, Lars Østergaard, Andreas Andersen, Peter Aaby, Christian Erikstrup, Christian Wejse, for the Bissau HIV Cohort study group P14 HIV-infected adolescents in transition from pediatric to adult HIV care in Dakar, Senegal: sample characteristics and immunological and virological profiles Siry Dieye, Moussa Sarr, Haby Sy, Helene D Mbodj, Marianne Ndiaye, Amy Ndiaye, Seydi Moussa, Assan Jaye, Souleymane Mboup100 P15 Molecular characterization of vertically transmitted HIV-1 among children born to HIV-1 seropositive mothers in Northern Tanzania Balthazar M. Nyombi, Elichilia R. Shao, Innocent B. Chilumba, Sikhulile Moyo, Simani Gaseitsiwe, Rosemary Musonda P16 Breast-fed HIV-1 exposed infants play catch up. A preliminary report Pam Datong, Bucky Inyang, Sophia Osawe, Abel Izang, Chundung Cole, Felicia Okolo, Bill Cameron, Kenneth Rosenthal, Clive Gray, Heather Jaspan, Alash’le Abimiku, the INFANT study team P17 The frequency of N348I mutation in patient failing combination antiretroviral treatment In Botswana Boitumelo Seraise, Kerstin Andrea-Marobela, Sikhulile Moyo, Rosemary Musonda, Joseph Makhema, Max Essex, Simani Gaseitsiwe
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Canning P, Bates J, Hammen K, Coetzee J, Wulf L, Rajewski S, Wang C, Karriker L. Concentrations of tylvalosin and 3-O-acetyltylosin attained in the synovial fluid of swine after administration by oral gavage at 50 and 5 mg/kg. J Vet Pharmacol Ther 2016; 39:621-624. [PMID: 27086612 DOI: 10.1111/jvp.12309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 03/11/2016] [Indexed: 11/28/2022]
Abstract
The objectives of this study were to determine the concentration of tylvalosin (TVN) and its metabolite, 3-O-acetyltylosin (3AT) in the synovial fluid of growing pigs when administered as a single bolus by oral gavage at target doses of 50 mg/kg (Trial 1) and 5 mg/kg (Trial 2). TVN is a water soluble macrolide antimicrobial used in swine production. The stability of the drug in synovial fluid samples stored at -70 °C up to 28 days was also evaluated in Trial 2. In Trial 1, eight pigs were randomly assigned to one of eight time points for euthanasia and synovial fluid collection: 0, 1, 2, 3, 4, 6, 9, 12 h postgavage. For Trial 2, 24 pigs were randomly allocated to one terminal collection time point at 0, 2, 4, 6, 8 or 10 h postgavage. Synovial fluid was analyzed to determine TVN and 3AT concentrations. TVN and 3AT were detected in Trial 1 at all time points, except 0 h. At 2 h postgavage for trial 2, the mean concentrations peaked at 31.17 ng/mL (95% CI: 18.62-52.16) for TVN and at 58.82 ng/mL (95% CI: 35.14-98.46) for 3AT. Storage duration did not impact TVN or 3AT concentrations (P-value 0.9732).
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Affiliation(s)
- P Canning
- Swine Medicine Education Center, College of Veterinary Medicine, Iowa State University, Ames, IA, USA
| | - J Bates
- Swine Medicine Education Center, College of Veterinary Medicine, Iowa State University, Ames, IA, USA
| | - K Hammen
- Swine Medicine Education Center, College of Veterinary Medicine, Iowa State University, Ames, IA, USA
| | - J Coetzee
- Pharmacology Analytical Support Team, Veterinary Diagnostic Laboratory, Iowa State University, Ames, IA, USA
| | - L Wulf
- Pharmacology Analytical Support Team, Veterinary Diagnostic Laboratory, Iowa State University, Ames, IA, USA
| | - S Rajewski
- Pharmacology Analytical Support Team, Veterinary Diagnostic Laboratory, Iowa State University, Ames, IA, USA
| | - C Wang
- Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA, USA
| | - L Karriker
- Swine Medicine Education Center, College of Veterinary Medicine, Iowa State University, Ames, IA, USA.
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Otwombe KN, Dietrich J, Sikkema KJ, Coetzee J, Hopkins KL, Laher F, Gray GE. Exposure to and experiences of violence among adolescents in lower socio-economic groups in Johannesburg, South Africa. BMC Public Health 2015; 15:450. [PMID: 25930034 PMCID: PMC4419458 DOI: 10.1186/s12889-015-1780-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 04/22/2015] [Indexed: 12/02/2022] Open
Abstract
Background We explored exposure to and experiences of violence and their risk factors amongst ethnically diverse adolescents from lower socio economic groups in Johannesburg. Methods This cross-sectional study recruited a stratified sample of 16–18 year old adolescents from four low socio-economic suburbs in Johannesburg to reflect ethnic group clustering. We collected socio-demographic, sexual behaviour, alcohol and drug use and trauma events data. Proportions and risk factors were assessed by chi-square and logistic regression. Results Of 822 adolescents, 57% (n = 469) were female. Approximately 62% (n = 506) were Black, 13% (n = 107) Coloured, 13% (n = 106) Indian and 13% (n = 103) White. Approximately 67% (n = 552) witnessed violence to a non-family member, 28% (n = 228) experienced violence by a non-family member, and 10% (n = 83) reported sexual abuse. Multivariate analysis determined that witnessing violence in the community was associated with being Black (OR: 4.6, 95%CI: 2.7-7.9), Coloured (OR: 3.9, 95%CI: 2.0-7.4) or White (OR: 8.0, 95%CI:4.0-16.2), repeating a grade (OR: 1.5, 95%CI: 1.01-2.1), having more than one sexual partner (OR: 1.7, 95%CI: 1.1-2.5) and ever taking alcohol (OR: 2.1, 95%CI: 1.5-2.9). Witnessing violence in the family was associated with being female (OR: 1.8, 95%CI: 1.3-2.6), being Black (OR: 2.2, 95%CI: 1.1-4.1), or White (OR: 3.0, 95%CI: 1.4-6.4), repeating a grade (OR: 1.6, 95%CI: 1.1-2.2) and ever taking alcohol (OR: 2.9, 95%CI: 2.0-4.3). Conclusions In low socio-economic areas in Johannesburg, Black, White and Coloured adolescents experience a high burden of violence. Interventions to mitigate the effects of violence are urgently required.
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Affiliation(s)
- Kennedy N Otwombe
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, P.O Box 114, , Diepkloof, 1864, Johannesburg, South Africa.
| | - Janan Dietrich
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, P.O Box 114, , Diepkloof, 1864, Johannesburg, South Africa.
| | - Kathleen J Sikkema
- Department of Psychology and Neuroscience, Duke Global Health Institute, Duke University, Durham, North Carolina, USA.
| | - Jenny Coetzee
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, P.O Box 114, , Diepkloof, 1864, Johannesburg, South Africa.
| | - Kathryn L Hopkins
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, P.O Box 114, , Diepkloof, 1864, Johannesburg, South Africa.
| | - Fatima Laher
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, P.O Box 114, , Diepkloof, 1864, Johannesburg, South Africa.
| | - Glenda E Gray
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, P.O Box 114, , Diepkloof, 1864, Johannesburg, South Africa.
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Bautista-Arredondo S, Sosa-Rubí SG, Opuni M, Kwan A, Chaumont C, Coetzee J, Condo J, Dzekedzeke K, Galárraga O, Martinson N, Masiye F, Nsanzimana S, Wamai R, Wang'ombe J. Assessing cost and technical efficiency of HIV prevention interventions in sub-Saharan Africa: the ORPHEA study design and methods. BMC Health Serv Res 2014; 14:599. [PMID: 25927555 PMCID: PMC4260235 DOI: 10.1186/s12913-014-0599-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 11/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Scaling up services to achieve HIV targets will require that countries optimize the use of available funding. Robust unit cost estimates are essential for the better use of resources, and information on the heterogeneity in the unit cost of delivering HIV services across facilities - both within and across countries - is critical to identifying and addressing inefficiencies. There is limited information on the unit cost of HIV prevention services in sub-Saharan Africa and information on the heterogeneity within and across countries and determinants of this variation is even more scarce. The "Optimizing the Response in Prevention: HIV Efficiency in Africa" (ORPHEA) study aims to add to the empirical body of knowledge on the cost and technical efficiency of HIV prevention services that decision makers can use to inform policy and planning. METHODS/DESIGN ORPHEA is a cross-sectional observational study conducted in 304 service delivery sites in Kenya, Rwanda, South Africa, and Zambia to assess the cost, cost structure, cost variability, and the determinants of efficiency for four HIV interventions: HIV testing and counselling (HTC), prevention of mother-to-child transmission (PMTCT), voluntary medical male circumcision (VMMC), and HIV prevention for sex workers. ORPHEA collected information at three levels (district, facility, and individual) on inputs to HIV prevention service production and their prices, outputs produced along the cascade of services, facility-level characteristics and contextual factors, district-level factors likely to influence the performance of facilities as well as the demand for HIV prevention services, and information on process quality for HTC, PMTCT, and VMMC services. DISCUSSION ORPHEA is one of the most comprehensive studies on the cost and technical efficiency of HIV prevention interventions to date. The study applied a robust methodological design to collect comparable information to estimate the cost of HTC, PMTCT, VMMC, and sex worker prevention services in Kenya, Rwanda, South Africa, and Zambia, the level of efficiency in the current delivery of these services, and the key determinants of efficiency. The results of the study will be important to decision makers in the study countries as well as those in countries facing similar circumstances and contexts.
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Affiliation(s)
| | - Sandra G Sosa-Rubí
- National Institute of Public Health (INSP), Division of Health Economics, Cuernavaca, Mexico.
| | | | - Ada Kwan
- National Institute of Public Health (INSP), Division of Health Economics, Cuernavaca, Mexico.
| | - Claire Chaumont
- National Institute of Public Health (INSP), Division of Health Economics, Cuernavaca, Mexico.
| | - Jenny Coetzee
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
| | - Jeanine Condo
- National University of Rwanda, School of Public Health, Kigali, Rwanda.
| | | | | | - Neil Martinson
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
| | - Felix Masiye
- University of Zambia, Division of Economics, Lusaka, Zambia.
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Govender R, Dietrich J, Coetzee J, Gilvray MM, Wilson D. A Qualitative Exploration of Medical Male Circumcision among Young Men from WhizzKids United, Edendale, Pietermaritzburg. AIDS Res Hum Retroviruses 2014. [DOI: 10.1089/aid.2014.5424.abstract] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Coetzee J, Dietrich J, Otwombe K, Nkala B, Khunwane M, van der Watt M, Sikkema KJ, Gray GE. Predictors of parent-adolescent communication in post-apartheid South Africa: a protective factor in adolescent sexual and reproductive health. J Adolesc 2014; 37:313-24. [PMID: 24636691 DOI: 10.1016/j.adolescence.2014.01.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 01/07/2014] [Accepted: 01/25/2014] [Indexed: 10/25/2022]
Abstract
In the HIV context, risky sexual behaviours can be reduced through effective parent-adolescent communication. This study used the Parent Adolescent Communication Scale to determine parent-adolescent communication by ethnicity and identify predictors of high parent-adolescent communication amongst South African adolescents post-apartheid. A cross-sectional interviewer-administered survey was administered to 822 adolescents from Johannesburg, South Africa. Backward stepwise multivariate regressions were performed. The sample was predominantly Black African (62%, n = 506) and female (57%, n = 469). Of the participants, 57% (n = 471) reported high parent-adolescent communication. Multivariate regression showed that gender was a significant predictor of high parent-adolescent communication (Black African OR:1.47, CI: 1.0-2.17, Indian OR: 2.67, CI: 1.05-6.77, White OR: 2.96, CI: 1.21-7.18). Female-headed households were predictors of high parent-adolescent communication amongst Black Africans (OR:1.49, CI: 1.01-2.20), but of low parent-adolescent communication amongst Whites (OR:0.36, CI: 0.15-0.89). Overall levels of parent-adolescent communication in South Africa are low. HIV prevention programmes for South African adolescents should include information and skills regarding effective parent-adolescent communication.
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Affiliation(s)
- Jenny Coetzee
- Perinatal HIV Research Unit, University of the Witwatersrand, Chris Hani Baragwanath Hospital, Johannesburg 1864, South Africa; Department of Human and Community Development, University of the Witwatersrand, Johannesburg 2000, South Africa; Canadian African Prevention Trials Network, Ottawa Hospital General Campus, Ottawa, ON K1H 8L6, Canada.
| | - Janan Dietrich
- Perinatal HIV Research Unit, University of the Witwatersrand, Chris Hani Baragwanath Hospital, Johannesburg 1864, South Africa; Department of Human and Community Development, University of the Witwatersrand, Johannesburg 2000, South Africa; Canadian African Prevention Trials Network, Ottawa Hospital General Campus, Ottawa, ON K1H 8L6, Canada
| | - Kennedy Otwombe
- Perinatal HIV Research Unit, University of the Witwatersrand, Chris Hani Baragwanath Hospital, Johannesburg 1864, South Africa
| | - Busi Nkala
- Perinatal HIV Research Unit, University of the Witwatersrand, Chris Hani Baragwanath Hospital, Johannesburg 1864, South Africa
| | - Mamakiri Khunwane
- Perinatal HIV Research Unit, University of the Witwatersrand, Chris Hani Baragwanath Hospital, Johannesburg 1864, South Africa
| | - Martin van der Watt
- Perinatal HIV Research Unit, University of the Witwatersrand, Chris Hani Baragwanath Hospital, Johannesburg 1864, South Africa
| | - Kathleen J Sikkema
- Department of Psychology and Neuroscience, and Global Health, Duke University, North Carolina 27710, USA
| | - Glenda E Gray
- Perinatal HIV Research Unit, University of the Witwatersrand, Chris Hani Baragwanath Hospital, Johannesburg 1864, South Africa; Department of Paediatrics, University of the Witwatersrand, Johannesburg 2000, South Africa
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Gumede LYE, Unemo M, Sriruttan C, Golparian D, Müller EE, Rebe K, Fick D, Wet JD, Coetzee J, Lewis DA. P1.020 Phenotypic and Genetic Characterization of the First Three Cases of Extended-Spectrum Cephalosporin Resistant Neisseria GonorrhoeaeInfection in South Africa and Association with Cefixime Treatment Failure. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Beneri CA, Zeldow B, Nachman S, Van der Linde M, Pillay E, Dittmer S, Kim S, Jean-Philippe P, Coetzee J, Bobat R, Hawkins E, Violari A. Loss to follow-up among infants in a study of isoniazid prophylaxis (P1041) in South Africa. Int J Tuberc Lung Dis 2013; 17:32-8. [PMID: 23232002 DOI: 10.5588/ijtld.12.0282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To assess risk factors for loss to follow-up (LFU) from the IMPAACT P1041 study, an isoniazid (INH) prophylaxis study conducted in southern Africa. DESIGN Infants in two cohorts, human immunodeficiency virus-infected (HIV+) and HIV-exposed but non-infected (HIV-), were randomized to INH or placebo for 96 weeks. LFU was evaluated at week 96. RESULTS Of 1351 infants, 12.9% were LFU (10.4% HIV+, 14.7% HIV-); 65% of the HIV+ cohort was asymptomatic. Among HIV+ infants, large household size (>6 vs. <4 members, P = 0.035) and presence of an elder (≥55 years, P = 0.05) were associated with better retention. Although attenuated in adjusted analysis, these associations held among HIV- infants. Among HIV- infants, having a younger mother increased the risk (P = 0.008) and maternal history of TB reduced the risk of LFU, the latter by nearly 70% (P = 0.048 univariate, 0.09 adjusted). LFU was largely due to inability to contact the participant (58% HIV+, 30% HIV-), and inability to attend the clinic and withdrawal of consent (HIV-). CONCLUSIONS Household support was an important factor in participant retention, particularly for the non-HIV-infected cohort, as young maternal age was a risk factor for LFU. Retaining study participants from this mobile population can be challenging and may warrant additional support.
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Affiliation(s)
- C A Beneri
- State University of New York at Stony Brook, Stony Brook, NY 11794-8111, USA.
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Lowman W, Sriruttan C, Nana T, Bosman N, Duse A, Venturas J, Clay C, Coetzee J. NDM-1 has arrived: first report of a carbapenem resistance mechanism in South Africa. S Afr Med J 2011; 101:873-875. [PMID: 22273027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Accepted: 10/31/2011] [Indexed: 05/31/2023] Open
Abstract
The New Delhi Metallo-β-lactamase (NDM) resistance mechanism in Enterobacteriaceae threatens to render serious Gram-negative infections untreatable. The NDM-1 enzyme hydrolyses all available penicillin, cephalosporin and carbapenem antibiotics, and is commonly accompanied by additional resistance mechanisms to multiple antibiotic classes. Initially identified as a significant healthcare risk on the Indian sub-continent, it has rapidly become a global problem, posing significant diagnostic and management challenges. Here we report the first laboratory-confirmed case of NDM-1 in South Africa.
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Hutchings L, Augustyn C, Cockcroft A, Van der Lingen C, Coetzee J, Leslie RW, Tarr RJ, Oosthuizen H, Lipinski MR, Roberts MR, Wilke C, Crawford R, Shannon LJ, Mayekiso M. Marine fisheries monitoring programmes in South Africa. S AFR J SCI 2010. [DOI: 10.4102/sajs.v105i5/6.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Guidozzi F, Alperstein A, Koller AB, de Villiers T, Coetzee J, Davey M, White R, Koll P, Kopenhager T, Dalmeyer P, Hayward F. Current knowledge of the effect of tibolone on the breast and uterus: an extract from the guidelines for the use of tibolone in South Africa. Southern African Journal of Gynaecological Oncology 2010. [DOI: 10.1080/20742835.2010.11441155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Botha ME, Coetzee J, Feldman C, Richards GA, Brink AJ. Activities of vancomycin, teicoplanin and linezolid against bacteraemic methicillin-resistant Staphylococcus aureus strains in Gauteng, South Africa. Crit Care 2009. [PMCID: PMC4084195 DOI: 10.1186/cc7473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Cotton M, Kim S, Rabie H, Coetzee J, Nachman S. A window into a public program for prevention of mother to child transmission of HIV: evidence from a prospective clinical trial. South Afr J HIV Med 2009; 10:16-19. [PMID: 20607114 DOI: 10.4102/sajhivmed.v10i4.257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVES: To evaluate efficacy of the antenatal, intra-partum and post-natal antiretroviral components of a public service Prevention of Mother to Child (MTCT) program in infants. DESIGN: Analysis of prospectively collected screening data of demographic and MTCT-related interventions and HIV-infection status of infants identified through HIV-specific DNA polymerase chain reaction. SETTING: Tygerberg Children's Hospital, Western Cape Province, South Africa. SUBJECTS: HIV-infected women and their infants identified through participation in a public service MTCT program were referred for possible participation in a prospective study of isoniazid prophylaxis. INTERVENTIONS: Key components of the Program include voluntary counselling and testing, zidovudine to the mother from between 28 and 34 weeks gestation and to the newborn infant for the first week, single dose nevirapine to the mother in labour and the newborn shortly after birth and free formula for 6 months. MAIN OUTCOME MEASURES: Number and percentage of HIV-infected infants and extent of exposure to antenatal, intrapartum and post-natal antiretrovirals. RESULTS: Of 656 infants with a median age of 12.6 weeks, screened between April 1(st) 2005 through May 2006, 39 were HIV-infected giving a transmission rate of 5.9% (95% CI: 4.4% - 8.0%). Antenatal prophylaxis was significantly associated with reduced transmission (OR: 0.43 (95% CI: 0.21 - 0.94)) as opposed to intrapartum and postpartum components (p=0.85 and p=0.84, respectively). In multivariable analysis the antenatal component remained significant (OR=0.40 (95% CI 0.19 - 0.90)). CONCLUSIONS: The antenatal phase is the most important antiretroviral component of the MTCT program, allowing most opportunity for intervention.
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Affiliation(s)
- M Cotton
- Centre for Infectious Diseases, Department of Paediatrics and Child Health and KID-CRU, Tygerberg Children's Hospital and Faculty of Health Sciences, Stellenbosch University
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Cotton MF, Schaaf HS, Lottering G, Weber HL, Coetzee J, Nachman S. Tuberculosis exposure in HIV-exposed infants in a high-prevalence setting. Int J Tuberc Lung Dis 2008; 12:225-227. [PMID: 18230259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Exposure to TB was quantified by screening human immunodeficiency virus (HIV) exposed infants aged 3-4 months for an isoniazid prophylaxis study where tuberculosis (TB) exposure excluded enrolment. Seventy-seven (10.1%, 95%CI 8.0-12.4) of 766 infants had contact with a TB source case. Nurses and lay counsellors identified 52 infants during pre-screening and doctors identified 25 during formal screening. High exposure may contribute to high rates of TB in HIV-exposed infants. Programs to prevent mother-to-child transmission of HIV offer an important opportunity to screen for TB. In-depth assessment is required for evaluating TB exposure.
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Affiliation(s)
- M F Cotton
- Department of Paediatrics and Child Health and Children's Infectious Diseases Clinical Research Unit (KID-CRU), Tygerberg Children's Hospital and Faculty of Health Sciences, Stellenbosch University, Tygerberg, South Africa.
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44
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Bennie L, Coetzee J, Malan E, Ferreira D. Structure and stereochemistry of triflavanoids containing both ether and carbon-carbon interflavanyl bonds. Phytochemistry 2001; 57:1023-1034. [PMID: 11423149 DOI: 10.1016/s0031-9422(01)00044-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The first triflavanoids with both C-C and C-O-C interflavanyl bonds, epioritin-(4beta-->6)-epioritin-(4alpha-->4)-epioritin-4beta-ol, epioritin-(4beta-->3)-epioritin-(4beta-->6)-epioritin-4beta-ol and epioritin-(4beta-->3)-epioritin-(4beta-->6)-epimesquitol-4alpha-ol, were identified in the heartwood of Acacia caffra. The ethereal interflavanyl bond is readily susceptible to reductive cleavage with sodium cyanoborohydride in trifluoroacetic acid/dichloromethane which hence permits the unequivocal assignment of the absolute configuration of constituent flavanyl units.
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Affiliation(s)
- L Bennie
- Department of Chemistry, University of the Orange Free State, PO Box 339, 9300, Bloemfontein, South Africa
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45
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Cloete SWP, Schoeman SJ, Coetzee J, Morris JDV. Genetic variances for liveweight and fleece traits in Merino, Dohne Merino and South African Meat Merino sheep. ACTA ACUST UNITED AC 2001. [DOI: 10.1071/ea00030] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
(Co)variance estimates for weaning weight, yearling liveweight, clean fleece
weight and fibre diameter at yearling age were obtained for Merino, Dohne
Merino and South African Meat Merino flocks maintained on the same property.
Direct additive genetic variances for weaning weight [expressed as a
ratio of the total phenotypic variance
(h2, direct heritability)]
were estimated at 0.15 for Merinos, 0.21 for Dohne Merinos and 0.32 for South
African Meat Merinos. Corresponding maternal variance ratios
(m2, including direct maternal
variance and permanent environmental maternal variance) were estimated at
0.15, 0.30 and 0.24, respectively. The correlation between direct and maternal
variance ratios was high and negative in Dohne Merinos and South African Meat
Merinos (–0.72 and –0.53, respectively). Direct heritability
estimates for yearling liveweight were 0.30 for Merinos, 0.33 for Dohne
Merinos and 0.45 for South African Meat Merinos. Corresponding maternal
variance ratios were only significant in the latter 2 breeds, amounting to
0.13 in Dohne Merinos and 0.12 in South African Meat Merinos. For yearling
clean fleece weight, h2 and
m2 were estimated at 0.28 and
0.12, respectively, for both Merinos and Dohne Merinos. In the case of South
African Meat Merinos, only the h2
estimate was significant, at 0.68. Maternal variance ratios for yearling fibre
diameter were not significant in any of the breeds, while
h2 ranged from 0.58 in Merinos to
0.75 in South African Meat Merinos. Selection progress for yearling traits
seems likely in all breeds, depending on the breeding objectives being strived
for.
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Bennie L, Malan E, Coetzee J, Ferreira D. Structure and synthesis of ether-linked proteracacinidin and promelacacinidin proanthocyanidins from Acacia caffra. Phytochemistry 2000; 53:785-793. [PMID: 10783984 DOI: 10.1016/s0031-9422(99)00618-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Two new ether-linked proanthocyanidins, epioritin-(4beta-->3)-epioritin-4beta-ol and epimesquitol-(4beta-->4)-epioritin-4beta-ol, were isolated from the heartwood of Acacia caffra. Their structures and absolute configurations were established by spectroscopic methods and syntheses.
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Affiliation(s)
- L Bennie
- Department of Chemistry, University of the Orange Free State, Bloemfontein, South Africa
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Coetzee J, Mciteka L, Malan E, Ferreira D. Structure and synthesis of the first procassinidin dimers based on epicatechin, and gallo- and epigallo-catechin. Phytochemistry 2000; 53:795-804. [PMID: 10783985 DOI: 10.1016/s0031-9422(00)00017-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The range of natural dimeric procassinidins is extended by identification of cassiaflavan-(4alpha-->8)-epicatechin, cassiaflavan-(4alpha 8)-epigallocatechin, cassiaflavan-(4beta-->8)-epicatechin, cassiaflavan-(4beta-->8)-epigallocatechin, cassiaflavan-(4beta-->8)-gallocatechin, ent-cassiaflavan-(4beta-->8)-epicatechin and cassiaflavan-(4alpha-->6)-epicatechin in the bark of Cassia petersiana. Their structures and absolute configuration were confirmed by synthesis.
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Affiliation(s)
- J Coetzee
- Department of Chemistry, University of the Orange Free State, Bloemfontein, South Africa.
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Mans BJ, Coetzee J, Louw AI, Gaspar AR, Neitz AW. Disaggregation of aggregated platelets by apyrase from the tick, Ornithodoros savignyi (Acari: Argasidae). Exp Appl Acarol 2000; 24:271-282. [PMID: 11110238 DOI: 10.1023/a:1006440714276] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Apyrase, secreted by ticks during feeding, is a platelet aggregation inhibitor that functions as a regulator of the host's hemostatic system. This present study concerns the disaggregation effect of salivary gland apyrase from the tick Ornithodoros savignyi. Secondarily aggregated platelets, disaggregated by apyrase, exhibited a reversal of shape from a spherical (aggregated) form to a discoid form, reminiscent of reversible aggregation at low ADP concentrations in citrated platelet-rich plasma. However, they showed a dilatory open canaliculary system and an absence of granules indicating disaggregation after degranulation had taken place. In contrast, disaggregation by the fibrin(ogen)olytic enzyme, plasmin, showed that platelets degranulated, but retained a spherical form with numerous extended pseudopods. While thrombin had no effect on aggregation or clotting of platelets disaggregated with plasmin, it did activate those platelets disaggregated with apyrase and clotted the plasma. This is the first study to describe the disaggregating effects of tick derived apyrase on aggregated platelets. It also shows that apyrase can disaggregate platelets even after secondary aggregation and degranulation of platelets has taken place. Platelet aggregation is one of the main barriers encountered by ticks during feeding and counteraction of this process by ticks is an important factor for successful feeding.
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Affiliation(s)
- B J Mans
- Department of Biochemistry, University of Pretoria, South Africa
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Conradie S, Coetzee A, Coetzee J. Anesthetic modulation of myocardial ischemia and reperfusion injury in pigs: comparison between halothane and sevoflurane. Can J Anaesth 1999; 46:71-81. [PMID: 10078408 DOI: 10.1007/bf03012519] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Halothane offers protection against the reperfusion injury of the myocardium. This study compared sevoflurane with halothane in its potential to modulate the effects of acute severe ischemia and reperfusion on the myocardium. METHODS Experiments were conducted on 25 pigs. Anesthesia consisted of thiopental, vecuronium and fentanyl. The lungs were mechanically ventilated with oxygen and nitrogen. Animals were randomly allocated to receive either I MAC halothane or sevoflurane. A control group received fentanyl and pentobarbital. Regional myocardial function was measured with sonomicrometers. The left anterior descending coronary artery was occluded for 15 min followed by 60 min reperfusion. RESULTS Neither halothane nor sevoflurane protected the heart against the effects of acute and severe regional myocardial ischemia. During reperfusion, 89% of the animals receiving sevoflurane suffered from ventricular fibrillation compared with 30% in the halothane group (P < 0.005). Five minutes into the reperfusion period the animals subjected to halothane anesthesia demonstrated an 88% recovery in regional myocardial systolic function while in the sevoflurane group the recovery was 40% of pre-ischemic control (P < 0.05). CONCLUSION Halothane is associated with less reperfusion arrhythmias and, in addition, recovery of regional myocardial function during reperfusion was more rapid in the presence of halothane than with sevoflurane.
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Affiliation(s)
- S Conradie
- Department of Anesthesiology, University of Stellenbosch Medical School, Tygerberg, South Africa
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Stoltz MA, van der Merwe CF, Coetzee J, Huismans H. Subcellular localization of the nonstructural protein NS3 of African horsesickness virus. Onderstepoort J Vet Res 1996; 63:57-61. [PMID: 8848304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The subcellular localization of the minor nonstructural protein NS3 of African horsesickness virus (AHSV) has been investigated by means of immunogold electron-microscopical analysis. NS3 was observed in perturbed regions of the plasma membrane of AHSV-infected VERO cells, and its presence appears to be associated with events of viral release. These events are budding, whereby released viruses acquire fragments from the host-cell membrane, as well as by the extrusion of nonenveloped particles through the cell membrane. The membrane association of NS3 was confirmed by its detection in the disrupted plasma membranes of cells infected with an NS3 baculovirus recombinant. The absence of NS3 on intact cell membranes suggests that the protein is not exposed extracellularly.
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Affiliation(s)
- M A Stoltz
- Department of Genetics, University of Pretoria, South Africa
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