When prevention is dangerous: perceptions of isoniazid preventive therapy in KwaZulu-Natal, South Africa

Setting

In 2011, the South African government began to offer isoniazid preventive therapy (IPT) through the public health system to presumptively treat latent tuberculous infection (LTBI) among people living with human immunodeficiency virus.

Objective

To describe IPT perceptions and experiences in three Zulu communities in KwaZulu-Natal Province, South Africa.

Design

Using a combination of community-based research and ethnographic methods, we undertook 17 individual and group interviews between October 2014 and May 2015. Interviews transcripts were analysed using qualitative content analysis and validated with grass-roots community advisors.

Results

Participants reported multiple ways in which IPT was perceived as dangerous: when costs related to pill collection or consumption were unsustainable, or when daily pill consumption resulted in stigma or was seen to introduce excess dirt or toxins, 'ukungcola', in the body. Theories on dirt are evoked to describe how IPT was perceived as 'matter out of place' when given to people who believed themselves to be healthy, suggesting that under the current TB aetiological model in Zulu culture, 'prevention as tablet' may not fit.

Conclusion

Implementing IPT without understanding the realities of community stakeholders can unintentionally undermine TB control efforts by worsening the situation for people who already encounter numerous daily problems.

Expression of neural cell-adhesion molecule isoforms and epithelial cadherin adhesion molecules in 47 human meningiomas: correlation with clinical and morphological data

Meningiomas are derived from arachnoidal cells exhibiting both epithelial and mesenchymal properties. The expression of epithelial cadherin and neural cell-adhesion molecule isoforms was examined in 47 meningioma specimens and normal arachnoid villi by using immunohistochemistry and immunoblot procedures. For immunohistochemistry, the percentage of immunostained surface versus counterstained surface and the intensity of labeling were quantified by image analysis and correlated with clinical and morphological data. Neural cell-adhesion molecule, 140-kDa, was expressed by all meningiomas examined and by cap cells and the fibrous capsule forming the arachnoid villi. Neural cell-adhesion-molecule immunostaining was correlated to tumor location, histological type, and grade. The expression of polysialylated isoforms was related to tumor location and grade, with a higher expression on convexity meningiomas and high-grade tumors. Epithelial cadherin was expressed with various intensity. In arachnoid villi, its expression was restricted to cap cells, but it was found in all meningiomas, whatever their histological type or grade. However, the expression was stronger in whorls and meningiotheliomatous areas versus fibroblastic areas. No correlation was observed with the tumor location or the grade. These data suggest that neural cell-adhesion molecule and epithelial cadherin play a role in the morphogenesis and histogenesis of human meningiomas.