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Faturiyele IO, Appolinare T, Ngorima-Mabhena N, Fatti G, Tshabalala I, Tukei VJ, Pisa PT. Outcomes of community-based differentiated models of multi-month dispensing of antiretroviral medication among stable HIV-infected patients in Lesotho: a cluster randomised non-inferiority trial protocol. BMC Public Health 2018; 18:1069. [PMID: 30157896 PMCID: PMC6116392 DOI: 10.1186/s12889-018-5961-0] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 08/14/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Current World Health Organization (WHO) guidelines recommend early initiation of HIV positive patients on antiretroviral therapy (ART) irrespective of their clinical or immunological status known as the test and start approach. Lesotho, like many other countries introduced this approach in 2016 as a strategy to reach epidemic control. There will be rapidly growing number of HIV-infected individuals initiating treatment leading to practical challenges on health systems such as congestion, long waiting time for patients and limited time to provide quality services to patients. Differentiated models of ART delivery is an innovative solution that helps to increase access to care, while reducing the burden on existing health systems. Ultimately this model will help to achieve retention and viral suppression. We describe a demonstration study designed to evaluate a community-based differentiated model of multi-month dispensing (MMD) approaches of ART among stable HIV patients in Lesotho. METHODS This study will be a three-arm cluster randomised trial, which will enrol approximately 5760 HIV-infected individuals who are stable on ART in 30 selected clusters. The clusters, which are health facilities, will be randomly assigned into the following differentiated model of care arms: (i) 3 monthly ART supply at facilities (Control), (ii) 3 monthly ART supply through community ART groups (CAGs) and (iii) 6 monthly ART supply through community ART distribution points (CAD). Primary outcomes are retention in care and virologic suppression, and secondary outcomes include feasibility and cost effectiveness. DISCUSSION Important lessons will be learnt to allow for improved implementation of such demonstration projects, including various needs for reliable supply of medication, access to quality clinical data including access to viral loads (VLs) results, frameworks to support lay worker cadre, involvement of community stakeholders, and reliable data systems including records of key indicators. MMD will have positive implications including improved retention, virologic suppression, convenience and access to medication. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03438370 . Accepted on 16 February 2018.
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Affiliation(s)
| | | | | | - G Fatti
- Kheth'Impilo AIDS Free Living, Cape Town, South Africa.,Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | | | | | - P T Pisa
- Right to Care/EQUIP, Centurion, South Africa.
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Singh E, Joffe M, Cubasch H, Ruff P, Norris SA, Pisa PT. Breast cancer trends differ by ethnicity: a report from the South African National Cancer Registry (1994-2009). Eur J Public Health 2018; 27:173-178. [PMID: 28177503 DOI: 10.1093/eurpub/ckw191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background To describe breast cancer (BC) incidence and mortality by ethnicity in South Africa (SA). Methods Sources of data included the South African National Cancer Registry (NCR) pathology-based reports (1994–2009) and Statistics South Africa (SSA) mortality data (1997–2009). Numbers of cases, age-standardised incidence rates (ASIR) and lifetime risk (LR) were extracted from the NCR database for 1994–2009. Age-specific incidence rates were calculated for five-year age categories. The direct method of standardisation was employed to calculate age-standardised mortality rates (ASMR) using mortality data. Results Between 1994 and 2009, there were 85 561 female BC. For the Black, Coloured and Asian groups, increases in ASIR and LR were observed between 1994 and 2009. In 2009, the ASIR for the total population, Blacks, Whites, Coloureds and Asians were 26.9, 18.7, 50.2, 40.9 and 51.2 per 100 000, respectively. For Asians, an increase in proportion of BC as a percentage of all female cancers was observed between 1994 and 2002 (11.1%) and continued to increase to 2009 (a further 4.5%). Whites and Asians presented higher incidences of BC at earlier ages compared with Blacks and Coloureds in 2009. In 1998, there were 1618 BC deaths in SA compared with 2784 deaths in 2009. ASMR between 1997 and 2004 increased but stabilised thereafter. Conclusion This paper demonstrated that SA BC incidence rates are similar to other countries in the region, but lower than other countries with similar health systems. Ethnic differences in BC trends were observed. However, the reasons for observed ethnic differences are unclear.
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Affiliation(s)
- E Singh
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa.,School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - M Joffe
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - H Cubasch
- Breast Unit, Department of Surgery, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | - P Ruff
- Faculty of Health Sciences, Division of Medical Oncology, University of Witwatersrand, Johannesburg, South Africa
| | - S A Norris
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - P T Pisa
- Wits Reproductive Health & HIV Institute, University of Witwatersrand, Johannesburg, South Africa
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Huybrechts I, De Vriendt T, Breidenassel C, Rogiers J, Vanaelst B, Cuenca-García M, Moreno LA, González-Gross M, Roccaldo R, Kafatos A, Clays E, Bueno G, Beghin L, Sjöstrom M, Manios Y, Molnár D, Pisa PT, De Henauw S. Mechanisms of stress, energy homeostasis and insulin resistance in European adolescents--the HELENA study. Nutr Metab Cardiovasc Dis 2014; 24:1082-9. [PMID: 24907850 DOI: 10.1016/j.numecd.2014.04.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 04/23/2014] [Accepted: 04/24/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Stress is hypothesized to facilitate the development of obesity, whose the foundations are already set during childhood and adolescence. We investigated the relationship between the stress-system, selected mechanisms of energy homeostasis and insulin resistance (IR) in a sample of European adolescents. METHODS AND RESULTS Within HELENA-CSS, 723 adolescents (12.5-17.5 years) from 10 European cities provided all the necessary data for this study. Fasting blood samples were collected for cortisol, leptin, insulin and glucose analysis. HOMA-IR was calculated from insulin and glucose concentrations. Adolescents' body fat (BF) %, age and duration of exclusive breastfeeding were assessed. For boys and girls separately, the relationship of cortisol with leptin, insulin, glucose and HOMA-IR was examined by computing Pearson correlation coefficients and Hierarchical Linear Models (HLMs), with 'city' as cluster unit, adjusting for age, BF% and duration of exclusive breastfeeding. In boys, Pearson correlation coefficients illustrated positive correlations of cortisol with insulin (r = 0.144; p = 0.013), glucose (r = 0.315; p < 0.001) and HOMA-IR (r = 0.180; p = 0.002), whilst in girls, this positive relationship was observed for leptin (r = 0.147; p = 0.002), insulin (r = 0.095; p = 0.050) and HOMA-IR (r = 0.099; p = 0.041), but not for glucose (r = 0.054; p = 0.265). Observed associations were independent of adolescents' age, BF% and duration of exclusive breastfeeding after computing HLMs. CONCLUSION This study suggests that the stress-system is positively related to mechanisms of energy homeostasis and IR in European adolescents, and reveals a potential small gender difference in this relationship. The hypothesis that stress might facilitate the development of obesity during adolescence is supported.
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Affiliation(s)
- I Huybrechts
- Department of Public Health, Ghent University, Ghent, Belgium; International Agency for Research on Cancer, Dietary Exposure Assessment Group, Lyon, France.
| | - T De Vriendt
- Department of Public Health, Ghent University, Ghent, Belgium; Research Foundation Flanders, Brussels, Belgium
| | - C Breidenassel
- ImFINE Research Group, Department of Health and Human Performance, Universidad Politécnica de Madrid, Spain; Department of Human Nutrition, Rheinische Friedrich-Wilhemls Universität, Bonn, Germany
| | - J Rogiers
- Department of Public Health, Ghent University, Ghent, Belgium
| | - B Vanaelst
- Department of Public Health, Ghent University, Ghent, Belgium; Research Foundation Flanders, Brussels, Belgium
| | - M Cuenca-García
- Department of Medical Physiology, School of Medicine, Granada University, Granada, Spain
| | - L A Moreno
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, School of Health Science (EUCS), University of Zaragoza, Zaragoza, Spain
| | - M González-Gross
- ImFINE Research Group, Department of Health and Human Performance, Universidad Politécnica de Madrid, Spain; Department of Human Nutrition, Rheinische Friedrich-Wilhemls Universität, Bonn, Germany
| | - R Roccaldo
- Istituto Nazionale di Ricerca per gli Alimenti e la Nutrizione (INRAN), Roma, Italy
| | - A Kafatos
- Department of Social Medicine, School of Medicine, Preventive Medicine and Nutrition Clinic, University of Crete, Crete, Greece
| | - E Clays
- Department of Public Health, Ghent University, Ghent, Belgium
| | - G Bueno
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, School of Health Science (EUCS), University of Zaragoza, Zaragoza, Spain
| | - L Beghin
- Inserm U955, IFR114, Faculty of Medicine, University Lille 2, Lille, France; CIC-9301-CH&U-Inserm of Lille, CHRU de Lille, Lille, France
| | - M Sjöstrom
- Unit for Preventive Nutrition, Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - Y Manios
- Department of Nutrition & Dietetics, Harokopio University, Athens, Greece
| | - D Molnár
- Department of Pediatrics, Medical Faculty, University of Pécs, Jzsef A 7, Pécs, Hungary
| | - P T Pisa
- International Agency for Research on Cancer, Dietary Exposure Assessment Group, Lyon, France; MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - S De Henauw
- Department of Public Health, Ghent University, Ghent, Belgium; University College Ghent Vesalius, Ghent, Belgium
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Pisa PT, Behanan R, Vorster HH, Kruger A. Social drift of cardiovascular disease risk factors in Africans from the North West Province of South Africa: the PURE study. Cardiovasc J Afr 2013; 23:371-8, e379-88. [PMID: 22914994 PMCID: PMC3721859 DOI: 10.5830/cvja-2012-018] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 03/05/2012] [Indexed: 12/02/2022] Open
Abstract
Objective This study examined whether the association between socio-economic status (SES) and cardiovascular disease (CVD) risk factors in black South Africans from the North West Province had shifted from the more affluent groups with higher SES to the less affluent, lower SES groups over a period of nine years. Method Cross-sectional baseline data of 2 010 urban and rural subjects (35 years and older) participating in the Prospective Urban and Rural (PURE) study and collected in 2005 were analysed to examine the relationship of level of education, employment and urban or rural residence with dietary intakes and other CVD risk factors. These relationships were compared to those found nine years earlier in the Transition and Health during the Urbanisation of South Africans (THUSA) study conducted in the same area. Results The results showed that urban women had higher body mass index (BMI), serum triglyceride and fasting glucose levels compared to rural women and that both urban men and women had higher blood pressures and followed a more Westernised diet. However, rural men and women had higher plasma fibrinogen levels. The more highly educated subjects (which included both urban and rural subjects) were younger than those with no or only primary school education. Few of the risk factors differed significantly between education groups, except that more highly educated men and women had lower BMIs, and women had lower blood pressure and triglyceride levels. These women also followed a more prudent diet than those with only primary school education. Employed men and women had higher BMIs, higher energy intakes but lower plasma fibrinogen levels, and employed women had lower triglyceride levels. No significant differences in total serum cholesterol values were observed. Conclusion These results suggest a drift of CVD risk factors from groups with higher SES to groups with a lower SES from 1996 to 2005, indicating that interventions to prevent CVD should also be targeted at Africans living in rural areas, those with low educational levels, and the unemployed.
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Affiliation(s)
- P T Pisa
- Centre of Excellence for Nutrition (CEN), North-West University, Potchefstroom, South Africa.
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Aderibigbe OR, Pisa PT, Mamabolo RL, Kruger HS, Vorster HH. The relationship between indices of iron status and selected anthropometric cardiovascular disease risk markers in an African population: the THUSA study. Cardiovasc J Afr 2011; 22:249-56. [PMID: 21556462 PMCID: PMC3721951 DOI: 10.5830/cvja-2011-015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 04/15/2011] [Indexed: 11/06/2022] Open
Abstract
There is evidence that certain indices of iron status are associated with anthropometric measures, which are used independently as markers of cardiovascular disease (CVD) risk. This study examined whether this association exists in an African population. The study was a cross-sectional comparative study that examined a total of 1 854 African participants. Ferritin was positively associated with body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), percentage body fat and subscapular skinfold thickness. Serum ferritin concentration was higher in the high-WHR category than the normal-WHR category for both genders. Additionally, WC and WHR increased with increasing ferritin concentrations in both genders. Serum iron was lower in the obese than the normal-weight and pre-obese women only. In this population-based study, increased serum ferritin concentrations associated positively with increased WHR and WC, indicating that individuals or populations at risk of iron overload as defined by high serum ferritin concentrations may be at a greater risk of developing CVD.
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Affiliation(s)
- O R Aderibigbe
- Centre of Excellence for Nutrition, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa.
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