1,721,349 research outputs found
Methods of gestational age assessment influence the observed association between antiretroviral therapy exposure, preterm delivery and small-for-gestational-age infants: a prospective study in Cape Town, South Africa
No full textPurpose:
Heterogeneous findings exist on antiretroviral treatment (ART) use in pregnancy and preterm delivery (PTD) or infants born small-for-gestational age (SGA). Whether reported differences may be explained by methods used to ascertain gestational age(GA) has not been explored.
Methods:
We enrolled consecutive pregnant women attending a large primary care antenatal clinic in South Africa. Public-sector midwives assessed GA by last menstrual period (LMP) and symphysis-fundal height (SFH). Separately, if clinical GA was <24weeks, ultrasound (US) was performed by a research sonographer blinded to midwife assessments. In analysis, the impact of measurement error on the association between HIV/ART status and birth outcome by GA method was assessed, and factors associated with clinical GA under- or over-estimation identified.
Results:
In 1787 women included overall, estimated PTD incidence was 36% by LMP, 17% by SFH and 11% by US. PTD risk was higher for HIV-infected than HIV-uninfected women using US-GA (adjusted odds ratio (aOR) 1.95; 95% CI 1.10-3.46); for LMP/SFH-GA the associations were smaller and not significant. These findings persisted after adjustment for age, parity, height and previous PTD. PTD risk did not vary by timing of ART initiation (before or during pregnancy) for any method. Elevated BMI and older age were associated with decreased risk of under-estimation by both LMP and SFH; HIV status and obesity were associated with increased risk of over-estimation by SFH. There were no differences in SGA incidence across GA methods.
Conclusions:
Findings for an association between HIV/ART and birth outcomes are substantially influenced by GA assessment method. With growing public health interest in this association, future research efforts should seek to standardize optimal measures of gestation
Safety of long-term isoniazid preventive therapy in children with HIV
No full textIncludes bibliographical references.Tuberculosis (TB) and HIV co-infection is association with significant morbidity and mortality, especially in young children. Prevention of tuberculosis in children with HIV is a global health priority and is best achieved through a combination of antiretroviral therapy (ART) and isoniazid preventive therapy (IPT). Current WHO guidelines recommend 6 months of IPT for all HIV-infected children older than 1 year without TB disease; up to 3 years is recommended in high TB prevalence areas. Although both ART and IPT can cause liver injury, data on the safety of IPT in HIV-infected children accessing ART is limited, and no published data exist on the hepatotoxicity risk of prolonged IPT. This thesis aims to address these knowledge gaps
Prevalence and incidence of renal dysfunction in patients initiating Antiretroviral Therapy at a Primary Health Care Centre in Gugulethu, Cape Town : a cohort study
No full textIncludes bibliographical references.Tenofovir disoproxil fumarate (TDF) is used worldwide for the treatment of HIV-1 infection. Tenofovir has been found to be associated with declines in renal function and chronic kidney disease in HIV-infected patients. There are limited data on how soon after antiretroviral therapy (ART) initiation any loss of renal function can be detected. We studied a cohort of HIV-infected adults initiating TDF-containing ART regimens at the Hannan Crusaid Antiretroviral Treatment Centre in Gugulethu. The centre provides ART to the residents of the Gugulethu and Nyanga districts situated on the outskirts of Cape Town. We described the prevalence and incidence of renal dysfunction in this cohort, the patterns of change in their renal function in the first 12 months on therapy and factors associated with renal dysfunction. We also examined the diagnostic value of early serum creatinine tests in identifying incident renal dysfunction after 12 months
Depression and HIV risk among female sex workers in Nelson Mandela Bay Municipality, South Africa: Results from a respondent-driven sampling study
Get PDFSex workers have a higher risk of acquiring and transmitting HIV as a result of social, structural, biomedical and behavioural factors. Many recent studies have highlighted that sex workers and other key populations experience higher levels of depression compared to the general population. Evidence is also emerging that mental health issues such as depression are related to HIV risk behaviour as well as the social and structural factors that leave sex workers vulnerable to bio-behavioural risks. The study protocol is described in Part A of this mini-dissertation. The study from which these data were derived is discussed in detail. Particular attention is placed on the use of respondent-driven sampling as a probabilistic method to estimate population proportion for hidden populations. The primary outcome, depression, and how it is measured through the Patient Health Questionnaire 9, is discussed in detail. The objective of measuring the prevalence of depression and assessing how it relates to risk factors is noted. The protocol argues that most research on sex workers focuses only on social, structural and bio-behavioural risk factors and rarely includes intrapersonal factors such as mental health. Based on this gap, it is argued that this research will help elucidate how depression, as an intrapersonal factor, relates to HIV risk. The literature review in Part B expands the argument that mental health in general and depression in particular are not given the attention they deserve as there are very few studies that measure mental health variables and even fewer that attempt to make any link between mental health, bio-behavioural risk and social vulnerabilities. The journal article in Part C offers empirical evidence that depression is higher among female sex workers than the general population and that depression is strongly associated with bio-behavioural and social risk factors. The article argues for more integration of mental health in research and programme implementation among sex workers
Brachytherapy and endoresection in the treatment of choroidal melanoma a review of patients treated in South Africa
No full textIncludes bibliographical references.This study is a retrospective cohort analysis of patients undergoing two different treatment modalities (brachytherapy and endoresection) for medium sized choroidal melanoma. Study methods involve the collection of baseline and follow-up data from three sources: 1) A database collected by the department of Radiation Oncology at Groote Schuur Hospital; 2) Private physicians responsible for patient follow-up following brachytherapy; 3) Private physicians responsible for endoresection surgery and patient follow-up. To date there has been limited publication of the outcomes of patients treated for choroidal melanoma in South Africa. The study aims to compare the outcomes of these procedures to help identify the possible benefits of each form of treatment
Estimating the resources needed and savings anticipated from roll-out of adult male circumcision in sub-Saharan Africa
Get PDFBackground: Trials in Africa indicate that medical adult male circumcision (MAMC) reduces the risk of HIV by 60%. MAMC may avert 2 to 8 million HIV infections over 20 years in sub-Saharan Africa and cost less than treating those who would have been infected. This paper estimates the financial and human resources required to roll out MAMC and the net savings due to reduced infections. Methods: We developed a model which included costing, demography and HIV epidemiology. We used it to investigate 14 countries in sub-Saharan Africa where the prevalence of male circumcision was lower than 80% and HIV prevalence among adults was higher than 5%, in addition to Uganda and the Nyanza province in Kenya. We assumed that the roll-out would take 5 years and lead to an MC prevalence among adult males of 85%. We also assumed that surgery would be done as it was in the trials. We calculated public program cost, number of full-time circumcisers and net costs or savings when adjusting for averted HIV treatments. Costs were in USD, discounted to 2007. 95% percentile intervals (95% PI) were estimated by Monte Carlo simulations. Results: In the first 5 years the number of circumcisers needed was 2 282 (95% PI: 2 018 to 2 959), or 0.24 (95% PI: 0.21 to 0.31) per 10 000 adults. In years 6-10, the number of circumcisers needed fell to 513 (95% PI: 452 to 664). The estimated 5-year cost of rolling out MAMC in the public sector was 672 million (95% PI: 437 to 1 021) and over 20 years there were net savings of $2.3 billion (95% PI: 1.4 to 3.4). Conclusion: A rapid roll-out of MAMC in sub-Saharan Africa requires substantial funding and a high number of circumcisers for the first five years. These investments are justified by MAMC's substantial health benefits and the savings accrued by averting future HIV infections. Lower ongoing costs and continued care savings suggest long-term sustainability
The prevalence and predictors of food insecurity among HIV-infected women in Cape Town, South Africa: A cross sectional study
Get PDFBackground: Food insecurity is a major public health concern in most settings where the Human Immunodeficiency Virus (HIV) is prevalent, and it affects women disproportionately. However, the prevalence of food insecurity and associated risk factors for women who are living with HIV (WLH) in South Africa is under researched. Methods: The researcher conducted a secondary, cross-sectional analysis of 346 HIV-infected women aged between 18 and 45, in Gugulethu, Cape Town. All participants were 12 months postpartum and enrolled into the MCH-ART study, a large implementation science study of antiretroviral use in pregnancy. For this study, women completed a 10-item household food security questionnaire that categorised food security status into household-level food insecurity, individual level food insecurity and children hunger. Using this tool, the level of food insecurity was categorised as food insecurity (“yes” to up to four questions), experiencing food insecurity (“yes” to five questions or more) and free from food insecurity (“no” to all questions). Results: Overall, the mean age was 29 years (SD: 5.46); 25 % of the women completed high school; 61 % were unemployed; nearly 66 % were free from food insecurity; and 25 % experienced food insecurity. Women who were employed were less likely to experience food insecurity when compared to those who were not employed (OR=0.54; 95 % CI: 0.32-0.90; p= 0.01). Those who completed high school were associated with food security than the ones who did not complete high school (OR= 0.5; 95 % CI: 0.28-0.97; p= 0.04). After adjusting for maternal age, marital and cohabiting status, education attainment, and parity, employment remained a significant predictor of experiencing food security (AOR= 0.55; 95 % CI: 0.32- 0.95 p=0.03) and educational attainment was no longer associated with food insecurity. Conclusions: The prevalence of food insecurity was relatively low in the urban-based sample of HIV-infected women. However, most of these HIV-infected women were obese and overweight. Thus, there is a clear need for more research to explore issues of food insecurity and nutrition in HIV-infected South African women
Mental health and chronic pain conditions in a nationally-representative sample of South African adults : a cross-sectional study
No full textIncludes bibliographical references (leaves 95-104).Chronic pain is considered a significant burden at both a personal and social level. Not only does it lead to individual suffering and loss of work or social roles, but it also places a great demand on health care systems. Chronic pain has been shown to be associated with both depression and anxiety disorders, adding to the drain on society. Most of the existing research on chronic pain and its association with mental disorders has focused on Europe and North America, with little research firom developing countries. There are few data on the prevalence of chronic pain at a population level in South Africa, and no research into the association between chronic pain and mental health. This study assessed the population prevaicnce and demographic characteristics of people with chronic pain conditions in South Africa, focusing on arthritisirhenrnatisrn and chronic back/neck pain, the two most common forms of chronic pain. The thesis examined the associations between these chronic pain conditions and common mental disorders in South Africa, with particular attention to possible gender differences in this association
Tuberculosis and hospitalization incidence postpartum among women living with HIV in Gugulethu, Western Cape, South Africa
Get PDFBackground: Knowledge of the incidence of tuberculosis (TB) and hospitalization postpartum could reduce maternal morbidity and mortality. TB infections are prevalent in pregnant women living with Human immunodeficiency virus (HIV) compared to women not living with HIV in South Africa. Adherence to Antiretroviral Therapy (ART) is poor among pregnant and postpartum women living with HIV (WLHIV), thus making WLHIV at a higher risk of hospitalization postpartum, due to the increased risk of Cesarean delivery (CD) and obstetric conditions as a result of HIV. The prevalence of TB among pregnant and postpartum women is poorly defined including in high prevalence TB and HIV locations, indicating limited evidence. The aim is to explore the incidence of TB and hospitalization within four years postpartum among WLHIV, including associated risk factors. Methodology: The study population is from phase 2 of the Maternal and Child HealthAntiretroviral Therapy (MCH-ART) study. It is a single-arm observational cohort study of 628 WLHIV who attended antenatal care (ANC). Enrolment into phase 1 began in March 2013, the final deliveries from phase 2 were in December 2014, and the final follow-up visits were completed in 2016. MCH-ART is an ongoing study with global approval examining strategies for providing HIV care and treatment to HIV-infected women who initiate ART during pregnancy and their HIV-exposed infants. This study took place at the Midwife-Obstetric Unit (MOU) at Gugulethu Community Health Centre, Western Cape South Africa. It consists of three connected study designs and three phases through the antenatal and postnatal periods. Phase 1 is a cross-sectional study, phase 2 is a cohort study and phase 3 is a randomized trial. Kaplan-Meier survival analysis was used to assess the incidence of TB and hospitalization over time among ix WLHIV up to four years postpartum and Cox regression was used to measure the effect of risk factors on the incidence of TB and hospitalization. Results: Thirty-five (35) WLHIV developed TB postpartum at a total person-time of 2365.1 woman-years. The incidence rate (IR) of developing TB among WLHIV postpartum was 1.48 (95% CI=1.03-2.06) cases per 100 woman-years from 2013 to 2018. Twenty-three (23) WLHIV was hospitalized postpartum and a total person-time of 552.8 woman-years was spent. The IR of hospitalization among WLHIV postpartum was 4.16 (95% CI=2.64-6.24) cases per 100 womanyears from 2013 to 2018. The IR of TB and hospitalization among WLHIV postpartum is statistically significant. Adjusting, for other risk factors, the history of diabetes at ANC, the history of TB at ANC and CD4 count (200 - <500) cells/mm3 at ANC also significantly increases the incidence of TB postpartum, whereas, obstetric reasons is associated with the hospitalization of WLHIV
Preventable deaths presenting to a level 1 trauma centre in South Africa : a panel study
No full textIncludes bibliographical references.The aim of our study was to identify areas for quality improvement in regards to preventable trauma deaths at Groote Schuur Hospital Trauma Centre (GSHTC)
- …
