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Journal articles on the topic 'Ecumenical HIV/AIDS Initiative in Africa'
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Lusey, Hendrew G., Monica Christianson, Miguel San Sebastian, and Kerstin E. Edin. "Church representatives’ perspectives on masculinities in the context of HIV: the case of the Ecumenical HIV and AIDS Initiative in Africa." African Journal of AIDS Research 15, no. 3 (September 28, 2016): 273–81. http://dx.doi.org/10.2989/16085906.2016.1203341.
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Szto, Courtney. "Saving Lives With Soccer and Shoelaces: The Hyperreality of Nike (RED)." Sociology of Sport Journal 30, no. 1 (March 2013): 41–56. http://dx.doi.org/10.1123/ssj.30.1.41.
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Product (RED) was launched in 2006 as an initiative to activate the corporate sector in the fight against HIV/AIDS in Africa. In 2009, Nike joined Product (RED)’s list of corporate partners with its “Lace Up, Save Lives” campaign. Nike (RED) directs 100% of its profits toward HIV/AIDS treatment and prevention through the Global Fund to Fight AIDS, Tuberculosis and Malaria and grassroots soccer programs in Africa. This case study questions the symbolism projected by Nike (RED) and its implications by applying Jean Baudrillard’s theories on consumption and hyperreality. The manner in which Nike (RED) represents Africa, HIV/AIDS, soccer, and sport for development and peace are all discussed as mediated simulations that position Nike as the producer of knowledge. Data analysis observes that Nike (RED) laces produce a hyperreality, whereby the origin of truth becomes, according to Baudrillard, indecipherable and soccer becomes more important than HIV/AIDS.
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Powers, Theodore. "Knowledge practices, waves and verticality: Tracing HIV/AIDS activism from late apartheid to the present in South Africa." Critique of Anthropology 37, no. 1 (February 22, 2017): 27–46. http://dx.doi.org/10.1177/0308275x16671788.
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As the South African HIV/AIDS epidemic enters its fourth decade, universal access to treatment has begun to extend the lives of people living with HIV/AIDS. While the South Africa’s ruling party – the African National Congress – has seized on improved health to bolster their political profile, the key agitators in producing this outcome were South African HIV/AIDS activists. Narrative accounts of the extended initiative have focused on the organisations that led the campaign for treatment access, such as the Treatment Access Campaign. Reflecting present trends in social movement theory, the emphasis in these accounts has been on transnational and/or ‘horizontal’ ties in alliance building. This approach obscures continuities with early South African HIV/AIDS activism during the late apartheid era. The concept of verticality is proposed as a means of highlighting the role of interpersonal relationships in the development of institutions and transmission of knowledge practices that link the waves of South African HIV/AIDS activism.
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Muula, Adamson S., and Joseph M. Mfutso-Bengo. "Important but Neglected Ethical and Cultural Considerations in the Fight Against HIV/AIDS in Malawi." Nursing Ethics 11, no. 5 (September 2004): 479–88. http://dx.doi.org/10.1191/0969733004ne726oa.
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Southern African countries have the highest HIV infection rates in the world. In most of the countries in the region, the rate among adults is at least 10%. The fight against HIV/AIDS has mostly been inadequate owing to the lack of proper consideration of ethical and cultural issues. In this article, the authors discuss the ethical and cultural dilemmas concerning HIV/AIDS, with Malawi as a case in point. It is argued that increasing financial resources alone, as exemplified by the Global Fund to Fight AIDS, Tuberculosis and Malaria initiative, without proper attention to ethical issues, morals and appropriate legal obligations, are unlikely to reduce the spread of HIV in southern Africa.
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D'Angelo, Paul, John C. Pollock, Kristen Kiernicki, and Donna Shaw. "Framing of AIDS in Africa: Press-state relations, HIV/AIDS news, and journalistic advocacy in four sub-Saharan Anglophone newspapers." Politics and the Life Sciences 32, no. 2 (2013): 100–125. http://dx.doi.org/10.2990/32_2_100.
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This study offers the first systematic analysis of the impact of press-state relations, or media systems, on the HIV/AIDS news agenda in African news coverage. The premise is that media systems play a determining role in the degree to which journalists can independently advocate for social change when covering HIV/AIDS. Drawing on comparative research, four sub-Saharan countries were categorized into two media systems: Contained Democratic (South Africa, Nigeria) and Repressive Autocratic (Zimbabwe, Kenya). A sample of HIV/AIDS stories (n = 393) published from 2002–2007 in each country's leading Anglophone newspaper was content analyzed. Across all coverage, the topic of social costs was framed more for the responsibility borne by nongovernmental agents than governmental agents. In Contained Democratic media systems, however, story emphasis shifted toward government agents taking responsibility for addressing the social costs of HIV/AIDS. Prevention campaigns were framed more as progress than decline across all newspapers; however, campaigns were reported as being more efficacious in Contained Democratic systems than in Repressive Autocratic systems. No impact of media system on framing of medical developments was found. Results show the value of comparative analysis in understanding the agenda-setting process: with greater emphasis on positive efficacy and government initiative, the news agenda in Contained Democratic media systems can facilitate stronger positive societal-level responses than the news agenda in Repressive Autocratic media systems.
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Jacobson, Laura E. "President's Emergency Plan for AIDS Relief (PEPFAR) Policy Process and the Conversation around HIV/AIDS in the United States." Journal of Development Policy and Practice 5, no. 2 (July 2020): 149–66. http://dx.doi.org/10.1177/2455133320952210.
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In 2003, the George W. Bush administration passed the President’s Emergency Plan for AIDS Relief (PEPFAR), a US government initiative to address the human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) epidemic primarily in Africa. PEPFAR’s US$18 billion budget remains the largest commitment from any nation towards a single disease and has saved countless lives. Given the historical and current political resistance to foreign aid, PEPFAR’s drastic spike in spending on HIV/AIDS raises questions over how the policy process resulted in bipartisan support. Using two policy process theories, punctuated equilibrium theory (PET) and the Narrative Policy Framework (NPF), this analysis helps explain the framing of the global HIV/AIDS epidemic and the factors that resulted in the creation of PEPFAR. The analysis of the PEPFAR policy process reveals a ‘tipping point’ in the early 2000s, when political actors, the media and advocacy coalitions benefitted from issue framing, narrative change and measures of political attention to elevate the global HIV/AIDS crisis to the public agenda. The findings highlight an increase in presidential attention, the evolution of the HIV/AIDS narrative away from stigma and the formation of powerful coalitions. Looking back on the combination of policy process factors that led to PEPFAR’s bipartisan success might lead to insights for dismantling the grand public health challenges of the present and future. This study’s findings have implications for currently stigmatised public health crises, such as the opioid epidemic.
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Brandon, Leslie Leila, and International Labour Office. "Action against HIV/AIDS in Africa: An Initiative in the Context of the World of Work." African Studies Review 44, no. 1 (April 2001): 153. http://dx.doi.org/10.2307/525414.
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Odediran, Omoladun O., Oluwakemi O. Odukoya, Mobolanle R. Balogun, Jonathan A. Colasanti, and Alani S. Akanmu. "A Qualitative Study Exploring Factors Associated with Retention in HIV Care among Women with HIV in a Large HIV Clinic in Lagos, Nigeria, after Implementing the Test and Treat Policy." AIDS Research and Treatment 2022 (August 9, 2022): 1–10. http://dx.doi.org/10.1155/2022/9074844.
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Background. In Nigeria, various sociocultural and economic factors may prevent women from being retained in HIV care. This study explores the factors associated with retention in care among women with HIV in a large HIV clinic in Lagos, Nigeria, under the Test and Treat policy. Methods. Women living with HIV/AIDS (n = 24) enrolled in an HIV study at the AIDS Prevention Initiative in Nigeria (APIN) clinic in Lagos, Nigeria, were interviewed from April 1 to October 31, 2021, using a semistructured interview guide. Interviews were audio-taped, transcribed verbatim, and the themes were analyzed using the framework of Andersen and Newman’s Behavioural Model for Healthcare Utilization. Results. The mean age of the respondents was 37.4 ± 9.27 years. The identified themes were as follows: being aware of the antiretroviral medications and their benefits, the household’s awareness of the respondents’ HIV status, and the presence of social support. Other themes were the presence of a dependable source of income and the ability to overcome the challenges encountered in obtaining income, ease of travel to and from the clinic (length of travel time and transportation costs), securing support from the clinic, challenges encountered in the process of accessing care at the clinic, and the ability to overcome these challenges. Also mentioned were self-perception of being HIV positive, motivation to remain in care, linkage to care, and intention to stay in care. Conclusion. Several deterring factors to retention in HIV care, such as nondisclosure of status, absence of social support, and clinic barriers, persist under the Test and Treat policy. Therefore, to achieve the “treatment as prevention” for HIV/AIDS, especially in sub-Saharan Africa, it is essential to employ strategies that address these barriers and leverage the facilitators for better health outcomes among women with HIV/AIDS.
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Chipukuma, Julian, Brianna Lindsay, Linah K. Mwango, Pawel Olowski, Caitlin Baumhart, Kalima Tembo, Adebayo A. Olufunso, et al. "Fostering Access to PrEP Among Adolescent Girls and Young Women Aged 16 to 24 Years at High Risk of HIV Through the DREAMS Initiative in Four Districts in Zambia." AIDS Education and Prevention 35, Supplement A (July 2023): 52–66. http://dx.doi.org/10.1521/aeap.2023.35.suppa.52.
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Adolescent girls and young women (AGYW) in sub-Saharan Africa remain at high risk for HIV, yet limited data exist on implementation of HIV pre-exposure prophylaxis (PrEP) for this group. We examined PrEP uptake among AGYW using a retrospective cohort enrolled in the Determined Resilient Empowered AIDS-free Mentored Safe (DREAMS) initiative in Zambia between October 2020 and March 2022. Consent was obtained from eligible AGYW at substantial risk for HIV, and they voluntarily participated in PrEP. Multivariable logistic regression was used to examine factors associated with PrEP refills following initiation. Of 4,162 HIV-negative AGYW, 3,233 (77%) were at substantial risk and initiated on PrEP. Overall, 68% of AGYW had at least one refill, but this differed significantly by age group and district. DREAMS was successful at reaching AGYW with PrEP services. More evidence is needed to assess reasons for discontinuation and to improve persistence for those with sustained HIV risk.
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Omosa-Manyonyi, Gloria Susan, Robert Langat, Bashir Farah, Elizabeth Mutisya, Hilda Ogutu, Jacquelyn Nyange, Jackton Indangasi, et al. "Establishment and implementation of a regional mucosal training program to facilitate multi-center collaboration in basic and clinical research in Eastern Africa." F1000Research 12 (September 28, 2023): 1243. http://dx.doi.org/10.12688/f1000research.138688.1.
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Background: The recent outbreaks of novel endemic and pandemic diseases have highlighted the importance of collaborative networks in rapid response to emerging pathogens. Over the last two decades International AIDS Vaccine Initiative (IAVI), with the support of United States Agency for International Development (USAID) and other international donors, has invested in research capacity and infrastructure in Africa. A significant portion of this support has facilitated establishing regional centers of excellence for African scientists to develop and lead a collaborative research agenda, implemented within the IAVI-led Accelerate the Development of Vaccines and New Technologies to Combat the AIDS Epidemic (ADVANCE) program. One such regional center is the University of Nairobi’s Kenya AIDS Vaccine Initiative-Institute of Clinical Research (KAVI-ICR). Objective: We designed and implemented a development program to foster inter-institutional South-South technology transfer within Africa, and address a capacity gap in mucosal research. Methods: KAVI-ICR and IAVI developed standardized mucosal sample collection, processing and technical assay methods; these were subsequently applied into several observational studies, and Phase I HIV vaccines, Varicella zoster virus vaccine, and broadly neutralizing antibodies clinical trials at KAVI-ICR. Thereafter, KAVI-ICR facilitated the technology transfer of the methods, by training staff at regional establishments in Africa. Results: Twelve standardized methodologies were developed for the collection, processing and storage of 10 mucosal sample types. Subsequently, eight regional research centers received training for a variety of clinical and laboratory methodologies; the centers later applied the techniques in follow-up collaborative research. Additionally, the training fostered collaboration while allowing the development of local networks of research groups. Conclusion: By such South-South initiatives, supported by international donors, the development of regional capacity and expertise is realizable. The established expertise can be leveraged when needed, and builds the capability for African scientists to engage at an international level, actively participating in driving internationally relevant research.
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Cheru, Fantu. "Debt relief & social investment: linking the HIPC initiative to the HIV/AIDS epidemic in Africa: the case of Zambia." Review of African Political Economy 27, no. 86 (December 2000): 519–35. http://dx.doi.org/10.1080/03056240008704487.
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Rivett, Ulrike, and Jonathan Tapson. "The Cell-Life Project: Converging technologies in the context of HIV/AIDS." Gateways: International Journal of Community Research and Engagement 2 (November 3, 2009): 82–97. http://dx.doi.org/10.5130/ijcre.v2i0.1166.
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This article presents the development of a technology initiative called Cell-Life which addresses the need for information management in the HIV/AIDS sector. Cell-Life started in 2001 as a research collaboration between staff of the Engineering Faculties at the University of Cape Town (UCT) and the Cape Peninsula University of Technology (CPUT). Based on the need to support the primary health care sector in providing sustainable treatment options for HIV+ people in under-resourced and rural areas, converging technologies were identified as a possible solution for creating a ‘virtual infrastructure’ between the patient and the medical staff.
In 2003 the Government of South Africa clarified in its operational plan for HIV/AIDS that anti-retroviral treatment (ART) increased life expectancy of people living with AIDS. It also highlighted that provision of anti-retroviral drugs (ARVs) required the regular assessment of the compliance rate to the treatment plan in order to avoid side effects and multiple resistant strains. For under-resourced primary health care centres in disadvantaged areas, HIV/AIDS treatment, and particularly the requirement to monitor patients regularly, became a near impossible task.
Cell-Life investigated the use of readily available information and communication technologies to support the provision and distribution of medication, continuous patient monitoring, and communication of relevant data. By combining open source software, cellular technologies and a new approach to software design, a variety of solutions were developed that would take cognisance of the context of HIV/AIDS support and treatment across the country.
In 2006 Cell-Life became a not-for-profit organisation and was spun out of the University of Cape Town. The organization currently implements Information Communication Technology (ICT) systems that (as of late 2009) manage the dispensation of ARVs to approximately 70 000 patients, representing one-sixth of South Africans on state- or donor-sponsored ART. This article reflects on the development of Cell-Life as a case study for one of the first socially responsible research projects in the Engineering field at UCT and highlights some of the challenges, enablers and barriers experienced.
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Nsibande, Duduzile F., Selamawit A. Woldesenbet, Adrian Puren, Peter Barron, Vincent I. Maduna, Carl Lombard, Mireille Cheyip, et al. "Investigating the quality of HIV rapid testing practices in public antenatal health care facilities, South Africa." PLOS ONE 17, no. 8 (August 29, 2022): e0268687. http://dx.doi.org/10.1371/journal.pone.0268687.
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Monitoring HIV prevalence using antenatal HIV sentinel surveillance is important for efficient epidemic tracking, programme planning and resource allocation. HIV sentinel surveillance usually employs unlinked anonymous HIV testing which raises ethical, epidemiological and public health challenges in the current era of universal test and treat. The World Health Organization (WHO) recommends that countries should consider using routine prevention of mother-to-child transmission of HIV (PMTCT) data for surveillance. We audited antenatal care clinics to assess the quality of HIV rapid testing practices as the first step to assess whether South Africa is ready to utilize PMTCT programme data for antenatal HIV surveillance. In 2017, we conducted a cross-sectional survey in 360 randomly sampled antenatal care clinics using the adapted WHO Stepwise-Process-for-Improving-the-Quality-of-HIV-Rapid-Testing (SPI-RT) checklist. We calculated median percentage scores within a domain (domain-specific median score), and across all domains (overall median percentage scores). The latter was used to classify sites according to five implementation levels; (from 0:<40% to 4: 90% or higher). Of 346 (96.1%) facilities assessed, an overall median percentage score of 62.1% (inter-quartile range (IQR): 50.8–71.9%) was obtained. The lowest domain-specific median percentage scores were obtained under training/certification (35% IQR: 10.0–50.0%) and external quality assurance (12.5% IQR: 0.0–50.0%), respectively. The majority (89%) of sites had an overall median score at level 2 or below; of these, 37% required improvement in specific areas and 6.4% in all areas. Facilities in districts implementing the HIV Rapid Test Quality Improvement Initiative and supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) had significantly higher median overall scores (65.6% IQR: 53.9–74.2%) (P-value from rank sum test: <0.001) compared with non–PEPFAR–supported facilities (56.6% IQR:47.7–66.0%). We found sub-optimal implementation of HIV rapid testing practices. We recommend the expansion of the PEPFAR-funded Rapid Test Continuous Quality Improvement (RTCQI) support to all antenatal care testing sites.
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Fiori, K., J. Schechter, and S. Houndeno. "Global health delivery science: Applying the care delivery value framework to a community based HIV/AIDS initiative in Togo, West Africa." Annals of Global Health 81, no. 1 (March 12, 2015): 190. http://dx.doi.org/10.1016/j.aogh.2015.02.936.
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Turton, Mervyn, and Sudeshni Naidoo. "Stigma and disclosure as barriers to regular dental care for people living with HIV/AIDS in Kwazulu-Natal and Western Cape, South Africa." Ethnicity and Inequalities in Health and Social Care 7, no. 1 (March 12, 2014): 49–59. http://dx.doi.org/10.1108/eihsc-05-2013-0006.
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Purpose – The purpose of this paper is to determine the oral health care experiences of people living with HIV in Kwazulu-Natal (KZN) and the Western Cape (WC) and also to identify the role of stigma and discrimination in the oral health care experiences for people living with HIV in KZN and the WC. Design/methodology/approach – This study was a survey among HIV-positive people attending selected Community Health Centres and regional hospitals, HIV clinics in KZN and WC provinces in South Africa. The sample consisted of people living with HIV that were 18 years or older and who had given written, informed consent. A cross-sectional study structure has been employed using a standardized format using a semi-structured interview and an administered questionnaire to collect data. The study classified participants as living in metropolitan or non-metropolitan areas. Findings – Apprehension of loss of confidentiality, stigma and discrimination were the barriers that deterred participants from seeking care. Respondents stated that they feared what the dentist and staff would think of them being HIV positive and feared being discriminated against by the dentist and staff. In some instances there appears to be a difference between policy and practice regarding the oral health care needs of and services rendered to people living with HIV in public health facilities as there are still patients who do not obtain care and for whom the attitudes of the health care provider constitutes the major barrier to accessing that care. Research limitations/implications – The results are specific to KZN and WC and have to be extrapolated with caution to the rest of South Africa. Additionally, this study did not have a control group of HIV-negative people which would have enabled one to determine whether certain barriers were unique to people living with HIV. Practical implications – To make recommendations with respect to addressing the issue of stigma and discrimination in the oral health care experiences for people living with HIV in KZN and the WC as there is a definite need for the government to address the resource needs of rural areas and less developed areas of South Africa. Health care is a much-needed resource in these high prevalence areas and governments must ensure that all their HIV/AIDS projects and policies should have a rural component built into them. Social implications – This study emphasizes the importance of embracing people that are being discriminated and marginalized by society such as people living with HIV to ensure that they feel a franchised member of society who can take the initiative to be in control of their own health and, with the necessary aid from public resources and societal support, join forces to reduce the public health burden and its impact on the socio-economic milieu. Originality/value – To the best of the author's knowledge, there is no other study that has compared differences in the use of oral health care services by people with HIV in South Africa and these results serve as an indication of some the important issues in this regard.
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Cooper, Melinda. "The Theology of Emergency: Welfare Reform, US Foreign Aid and the Faith-Based Initiative." Theory, Culture & Society 32, no. 2 (January 27, 2014): 53–77. http://dx.doi.org/10.1177/0263276413508448.
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This article addresses the rise of faith-based emergency relief by examining the US President’s Emergency Plan for HIV/AIDS (PEPFAR), a public health intervention focused on the AIDS epidemic in sub-Saharan Africa. It argues that the theological turn in humanitarian aid serves to amplify ongoing dynamics in the domestic politics of sub-Saharan African states, where social services have assumed the form of chronic emergency relief and religious organizations have come to play an increasingly prominent role in the provision of such services. In the context of an ongoing public health crisis, PEPFAR has institutionalized the social authority of the Pentecostal and charismatic churches, leading to a semantic confluence between the postcolonial politics of emergency and the Pentecostal/Pauline theology of kairos or event. Far from being confined to the space of foreign aid, however, the faith-based turn in humanitarianism is in keeping with ongoing reforms in domestic social policy in the United States. While on the one hand the sustained welfare programmes of the New Deal and Great Society have been dismantled in favour of a system of emergency relief, on the other hand the federal government has intensified its moral, pedagogical and punitive interventions into the lives of the poor. The wilful transfer of welfare services to overtly religious service providers has played a decisive role in this process. The article concludes with a critical appraisal of the links between African and North American Pentecostal-evangelical churches and questions the revolutionary mission ascribed to Pauline political theology in recent political theory.
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Uzoma Igwe, Chidi, Emmanuel Emagba Ewuga, Cosmas Onyedikachi Ujowundu, Ignatius Oparaji Onyeocha, and Viola Adaku Onwuliri. "Serum protein concentration and amino acid profile of HIV/HBV co-infected subjects on HAART in Plateau State, Nigeria." African Health Sciences 22, no. 1 (April 29, 2022): 418–30. http://dx.doi.org/10.4314/ahs.v22i1.51.
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Background: Human immunodeficiency virus (HIV) and hepatitis B virus (HBV) are currently two important blood-borne human pathogens of major public health concern with high prevalence rates in Africa.
Objectives: The study assessed the impact of HIV and HBV mono- and co-infections on serum total protein, albumin, globulin fractions and plasma free amino acids concentrations.
Methods: This was a cross-sectional study on adult (25 – 64 years old) patients on Highly Active Antiretroviral Therapy attending AIDS Preventive Initiative in Nigeria Centre, Jos University Teaching Hospital, Plateau State, Nigeria. It involved 80 subjects; 20 HIV/HBV co-infected, 20 each of HIV and HBV mono-infected controls, and 20 seronegative controls.
Results: Significant (p<0.05) increases in total protein and gamma globulin but a reduction in albumin concentrations were observed in the HIV/HBV co-infected group. Similarly, significant (p<0.05) increases in alpha-1 and alpha-2 globulin concentrations were observed in the mono- and co-infected groups compared to the seronegative control group. There were significant (p<0.05) increases in the glucogenic, aromatic and branched-chain amino acid concentrations of the HIV/HBV co-infected subjects.
Conclusion: The study suggests prognostic importance of alpha and gamma globulin fractions of serum protein as well as amino acid profile in the management of HIV/HBV co-infection.
Keywords: Total protein; albumin; globulin; amino acid; viral infection.
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Turton, Mervyn, and Sudeshni Naidoo. "Oral health care experiences of people living with HIV in Kwazulu-Natal and Western Cape, South Africa." International Journal of Human Rights in Healthcare 8, no. 2 (June 15, 2015): 59–69. http://dx.doi.org/10.1108/ijhrh-11-2013-0046.
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Purpose – The purpose of this paper is to ascertain the oral health experiences of people living with HIV/AIDS in the provinces of Kwazulu-Natal (KZN) and Western Cape (WC) in South Africa. Many studies have reported that people living with HIV have unmet needs for dental care and this study considered the various factors that affect the accessibility and utilisation of dental services as these factors are even more pertinent for the people living with HIV who have increased need for dental care. Design/methodology/approach – The participants were selected among HIV-positive people attending selected Community Health Centre and regional hospital HIV clinics in KZN and WC provinces. The sample consisted of people living with HIV that were 18 years or older and who had given written, informed consent. The sample (n=435) comprised mainly of black females in the age group 20-29 years. In total, 347 participants (79.8 per cent) had an oral health problem of which 83 per cent (n=288) received care. Findings – Of those that received care, 56.6 per cent (n=163) of the participants stated that the staff were aware of their HIV status. Almost a third of the participants who received care reported a negative experience at the clinic. If the participant lived in a metropolitan area, the participant was 3.647 times more likely to receive care than if the participant lived in a non-metropolitan area (p < 0.01) If the participant earned R5,000 or less, the participant was 0.106 times less likely to receive care (p=0.048). If the participant lived 1-5 km from the clinic, the participant was 3.371 times more likely to receive care (p=0.015). Research limitations/implications – The results are specific to KZN and WC and cannot be extrapolated with caution to the rest of South Africa. However, to the best of the author’s knowledge, there is no other study that has compared differences in the use of oral health care services by people with HIV in South Africa and these results serve as an indication of some the important issues in this regard. Additionally, this study did not have a control group of HIV-negative people which would have enabled one to determine whether certain barriers were unique to people living with HIV. Practical implications – The study highlighted the barriers to care existing within the current public health system relative to the provision of oral health services for people living with HIV in KZN and WC. It was anticipated that by ascertaining the nature and extent of unmet needs and barriers to dental care for people living with HIV, measures can be put in place to remove or at least reduce the barriers to care and improve the quality of life for people living with HIV/AIDS in South African communities. Social implications – The high prevalence of oral health problems in people living with HIV makes it imperative for the DOH to make every attempt to remove barriers to oral health care and thereby secure equitable, affordable and accessible oral health care which is acceptable for people living with HIV and accountable to the greater society. Originality/value – This study emphasises the importance of embracing people that are being discriminated and marginalised by society such as people living with HIV to ensure that they feel a franchised member of society who can take the initiative to be in control of their own health and, with the necessary aid from public resources and societal support, join forces to reduce the public health burden and its impact on the socio-economic milieu.
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Gray, Glenda E., Kenneth H. Mayer, Marnie L. Elizaga, Linda-Gail Bekker, Mary Allen, Lynn Morris, David Montefiori, et al. "Subtype C gp140 Vaccine Boosts Immune Responses Primed by the South African AIDS Vaccine Initiative DNA-C2 and MVA-C HIV Vaccines after More than a 2-Year Gap." Clinical and Vaccine Immunology 23, no. 6 (April 20, 2016): 496–506. http://dx.doi.org/10.1128/cvi.00717-15.
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ABSTRACTA phase I safety and immunogenicity study investigated South African AIDS Vaccine Initiative (SAAVI) HIV-1 subtype C (HIV-1C) DNA vaccine encoding Gag-RT-Tat-Nef and gp150, boosted with modified vaccinia Ankara (MVA) expressing matched antigens. Following the finding of partial protective efficacy in the RV144 HIV vaccine efficacy trial, a protein boost with HIV-1 subtype C V2-deleted gp140 with MF59 was added to the regimen. A total of 48 participants (12 U.S. participants and 36 Republic of South Africa [RSA] participants) were randomized to receive 3 intramuscular (i.m.) doses of SAAVI DNA-C2 of 4 mg (months 0, 1, and 2) and 2 i.m. doses of SAAVI MVA-C of 1.45 × 109PFU (months 4 and 5) (n= 40) or of a placebo (n= 8). Approximately 2 years after vaccination, 27 participants were rerandomized to receive gp140/MF59 at 100 μg or placebo, as 2 i.m. injections, 3 months apart. The vaccine regimen was safe and well tolerated. After the DNA-MVA regimen, CD4+T-cell and CD8+T-cell responses occurred in 74% and 32% of the participants, respectively. The protein boost increased CD4+T-cell responses to 87% of the subjects. All participants developed tier 1 HIV-1C neutralizing antibody responses as well as durable Env binding antibodies that recognized linear V3 and C5 peptides. The HIV-1 subtype C DNA-MVA vaccine regimen showed promising cellular immunogenicity. Boosting with gp140/MF59 enhanced levels of binding and neutralizing antibodies as well as CD4+T-cell responses to HIV-1 envelope. (This study has been registered at ClinicalTrials.gov under registration no. NCT00574600 and NCT01423825.)
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Jamieson, Lise, Leigh F. Johnson, Katleho Matsimela, Linda Alinafe Sande, Marc d'Elbée, Mohammed Majam, Cheryl Johnson, et al. "The cost effectiveness and optimal configuration of HIV self-test distribution in South Africa: a model analysis." BMJ Global Health 6, Suppl 4 (July 2021): e005598. http://dx.doi.org/10.1136/bmjgh-2021-005598.
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BackgroundHIV self-testing (HIVST) has been shown to be acceptable, feasible and effective in increasing HIV testing uptake. Novel testing strategies are critical to achieving the UNAIDS target of 95% HIV-positive diagnosis by 2025 in South Africa and globally.MethodsWe modelled the impact of six HIVST kit distribution modalities (community fixed-point, taxi ranks, workplace, partners of primary healthcare (PHC) antiretroviral therapy (ART) patients), partners of pregnant women, primary PHC distribution) in South Africa over 20 years (2020–2039), using data collected alongside the Self-Testing AfRica Initiative. We modelled two annual distribution scenarios: (A) 1 million HIVST kits (current) or (B) up to 6.7 million kits. Incremental economic costs (2019 US$) were estimated from the provider perspective; assumptions on uptake and screening positivity were based on surveys of a subset of kit recipients and modelled using the Thembisa model. Cost-effectiveness of each distribution modality compared with the status-quo distribution configuration was estimated as cost per life year saved (estimated from life years lost due to AIDS) and optimised using a fractional factorial design.ResultsThe largest impact resulted from secondary HIVST distribution to partners of ART patients at PHC (life years saved (LYS): 119 000 (scenario A); 393 000 (scenario B)). However, it was one of the least cost-effective modalities (A: $1394/LYS; B: $4162/LYS). Workplace distribution was cost-saving ($52–$76 million) and predicted to have a moderate epidemic impact (A: 40 000 LYS; B: 156 000 LYS). An optimised scale-up to 6.7 million tests would result in an almost threefold increase in LYS compared with a scale-up of status-quo distribution (216 000 vs 75 000 LYS).ConclusionOptimisation-informed distribution has the potential to vastly improve the impact of HIVST. Using this approach, HIVST can play a key role in improving the long-term health impact of investment in HIVST.
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Mwaura, Philomena Njeri. "Integrity of Mission in the Light of the Gospel: Bearing Witness of the Spirit Among Africa's Gospel Bearers." Exchange 35, no. 2 (2006): 169–90. http://dx.doi.org/10.1163/157254306776525690.
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AbstractThe church in Africa like its counterparts elsewhere in the world is called to fulfil the mission of Christ which is basically two fold; to liberate humankind on the social-political and economic plane and to lead them to salvation on the eschatological plane. This is self-evident for Christ was not only concerned with the spiritual needs of the people, but material as well. The question therefore arises how does the church in Africa bear witness to the spirit of God and conduct her mission with integrity in its contextual realities of HIV/AIDS, refugee crises, poverty, corruption and abuse of human rights? This paper argues that though the church faces this onerous task it is vibrant, alive and dynamic but for her to be relevant and effective she must develop more imaginative ways of doing mission, being church and theological formation. She needs to be a reconciler, mediating peace and healing due to the deep hurts and painful experiences the continent has encountered over the years. This calls for an ecumenical mission and vision that entails partnering in suffering by accompanying those in pain. She needs to disciple the members through surrendering herself to Christ to be purified, sanctified and renewed. She needs to provide courageous, empowered and effective leadership with moral integrity. She also needs to embody the spirit of unity and reconciliation in a pluralistic context and extend the biblical shalom of peace, justice to the marginalized poor, women displaced people, children, disabled and victims of all forms of violence. Mission with integrity also calls for listening to the other, dialogue and speaking out against all impediments to the gospel.
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Chimwaza-Manda, Wanangwa, Mphatso Kamndaya, Nanlesta Pilgrim, Sanyukta Mathur, Effie Kondwani Chipeta, and Yandisa Sikweyiya. "Social support and very young adolescent girl’s knowledge on sexual relationships: A comparative qualitative study of Girl Only Clubs’ participants and non-participants in rural Malawi." PLOS Global Public Health 3, no. 1 (January 12, 2023): e0001339. http://dx.doi.org/10.1371/journal.pgph.0001339.
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Early sexual relationships are associated with an increased risk of acquiring sexually transmitted diseases including HIV/AIDs, teenage pregnancies, and unsafe abortions among other negative health outcomes. Understanding sexual relationships among very young adolescents (VYAs) is important to equip them to protect themselves from negative sexual health (SH) outcomes. DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) is an HIV prevention initiative that provided an evidence-based core package of interventions to VYAs to prevent HIV acquisition in 15 countries in sub-Saharan Africa. The Girl Only Club (GOC) was the primary context for the interventions. Our objective in this study was to explore if there was any difference in social support (SS) received concerning sexual relationships between the VYA girls who attended GOCs and those who did not. In-depth interviews were conducted with 43 VYA girls, aged 10–14 years, in two rural southern districts, Zomba and Machinga, in Malawi. Twenty-three VYA girls were participants in GOCs and 20 VYA girls did not participate. A thematic, descriptive approach that involved a constant comparative analysis guided the data analysis, and Nvivo 12 software was used. In both study sites available SS concerning sexual relationships is informational support including information from parents, older relatives, and friends. However, club participants differed from non-club participants in sexual and reproductive health (SRH) knowledge and use. Club participants reported consulting others on decision-making and information on sexual relationships; receiving detailed SH information from clubs; condom use due to education received from the clubs; quitting sexual relationships; and correcting misinformation with club information. GOC participants received more SS which made them more knowledgeable and better at handling sexual relationship issues than those not in clubs. Interventions that integrate SS including social asset building and safe spaces are critical for VYA SRH programming.
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Homsy, Jaco, Rachel King, Joseph Tenywa, Primrose Kyeyune, Alex Opio, and Dorothy Balaba. "Defining Minimum Standards of Practice for Incorporating African Traditional Medicine into HIV/AIDS Prevention, Care, and Support: A Regional Initiative in Eastern and Southern Africa." Journal of Alternative and Complementary Medicine 10, no. 5 (October 1, 2004): 905–10. http://dx.doi.org/10.1089/1075553042476731.
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Breman, Joel G. "Eradicating Malaria." Science Progress 92, no. 1 (May 2009): 1–38. http://dx.doi.org/10.3184/003685009x440290.
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The renewed interest in malaria research and control is based on the intolerable toll this disease takes on young children and pregnant women in Africa and other vulnerable populations; 150 to 300 children die each hour from malaria amounting to 1 to 2 million deaths yearly. Malaria-induced neurologic impairment, anemia, hypoglycemia, and low birth weight imperil normal development and survival. Resistance of Plasmodium falciparum to drugs and Anopheles mosquitoes to insecticides has stimulated discovery and development of artemisinin-based combination treatments (ACTs) and other drugs, long-lasting insecticide-treated bednets (with synthetic pyrethroids) and a search for non-toxic, long-lasting, affordable insecticides for indoor residual spraying (IRS). Malaria vaccine development and testing are progressing rapidly and a recombinant protein (RTS,S/AS02A) directed against the circumsporozoite protein is soon to be in Phase 3 trials. Support for malaria control, research, and advocacy through the Global Fund for HIV/AIDS, Tuberculosis and Malaria, the U.S. President's Malaria Initiative, the Bill & Melinda Gates Foundation, WHO and other organizations is resulting in decreasing morbidity and mortality in many malarious countries. Sustainability of effective programs through training and institution strengthening will be the key to malaria elimination coupled with improved surveillance and targeted research.
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Burgers, Wendy A., Joanne H. van Harmelen, Enid Shephard, Craig Adams, Thandiswa Mgwebi, William Bourn, Tomáš Hanke, Anna-Lise Williamson, and Carolyn Williamson. "Design and preclinical evaluation of a multigene human immunodeficiency virus type 1 subtype C DNA vaccine for clinical trial." Journal of General Virology 87, no. 2 (February 1, 2006): 399–410. http://dx.doi.org/10.1099/vir.0.81379-0.
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In this study, the design and preclinical development of a multigene human immunodeficiency virus type 1 (HIV-1) subtype C DNA vaccine are described, developed as part of the South African AIDS Vaccine Initiative (SAAVI). Genetic variation remains a major obstacle in the development of an HIV-1 vaccine and recent strategies have focused on constructing vaccines based on the subtypes dominant in the developing world, where the epidemic is most severe. The vaccine, SAAVI DNA-C, contains an equimolar mixture of two plasmids, pTHr.grttnC and pTHr.gp150CT, which express a polyprotein derived from Gag, reverse transcriptase (RT), Tat and Nef, and a truncated Env, respectively. Genes included in the vaccine were obtained from individuals within 3 months of infection and selection was based on closeness to a South African subtype C consensus sequence. All genes were codon-optimized for increased expression in humans. The genes have been modified for safety, stability and immunogenicity. Tat was inactivated through shuffling of gene fragments, whilst maintaining all potential epitopes; the active site of RT was mutated; 124 aa were removed from the cytoplasmic tail of gp160; and Nef and Gag myristylation sites were inactivated. Following vaccination of BALB/c mice, high levels of cytotoxic T lymphocytes were induced against multiple epitopes and the vaccine stimulated strong CD8+ gamma interferon responses. In addition, high titres of antibodies to gp120 were induced in guinea pigs. This vaccine is the first component of a prime–boost regimen that is scheduled for clinical trials in humans in the USA and South Africa.
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Saint-Raymond, Agnes, Martin Harvey, and Maria Cavaller. "OC 8431 CLINICAL RESEARCH AND SUSTAINABLE DEVELOPMENT IN SUB-SAHARAN AFRICA: THE IMPACT OF NORTH-SOUTH PARTNERSHIPS." BMJ Global Health 4, Suppl 3 (April 2019): A5.3—A6. http://dx.doi.org/10.1136/bmjgh-2019-edc.12.
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BackgroundThe European legislation introduced in 2004 (under article 58) a collaboration tool to increase access to high quality and effective medicines in low- and middle-income countries. The European Medicines Agency (EMA) can provide scientific opinions on medicines intended for significant public health needs, in partnership with the World Health Organisation (WHO) and the relevant ‘target’ non-EU regulatory authorities. This EU-Medicines4all (EU-M4all) initiative contributes to the broader Global Health Mandate of the EU.MethodsWe contacted the pharmaceutical companies holding ‘article 58’ scientific opinions and compiled the number of actual approvals based on these opinions.ResultsNine medicines have been assessed so far, most of them for HIV/AIDS, tuberculosis, malaria and maternal/new-born health. Although this figure may appear low, the impact of the corresponding scientific opinions is much wider. Approvals were granted in 66 different countries worldwide, 38 of which are in Africa, based on these opinions.DiscussionSuch scientific opinions on the quality, safety and efficacy of the medicines are provided by the EMA’s Committee for Medicinal Products for Human Use (CHMP). Prior to this, it is recommended to agree on the data to be generated through scientific advice. The opinions are based on the same standards as used for those approved for Europe, with considerations for local conditions of use. To promote reliance on EMA scientific outputs and awareness of the procedure, two training events with regulators from Southern and from Western Africa are organised in partnership with WHO, NEPAD and local regulators in June 2018.ConclusionWe have shown that this ‘article 58’ procedure has a true impact and we encourage applications by companies developing medicines, aimed to prevent or treat diseases of significant public health interest, to be marketed outside the EU. This will ensure timely access of medicines by patients in target countries all over the world.
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Andrew Kiboneka. "The evolving burden of asthma and contemporary advances in management: Implications for clinical practice in Southern Africa." World Journal of Advanced Research and Reviews 8, no. 3 (December 30, 2020): 059–70. http://dx.doi.org/10.30574/wjarr.2020.8.3.0315.
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Asthma is a rising significant global public health burden especially in the developing countries. The annual prevalence of severe asthma episodes is estimated from 1% to 21% for adults and over 20% for children aged 6–7 years. The prevalence of asthma varies widely around the world, ranging from 0.2% to 21.0% in adults and from 2.8% to 37.6% in 6- to 7-year-old children. The International Study of Asthma and Allergies in Children (ISAAC) reports a significant increase in the global prevalence of asthmatic episodes among children. t was estimated that more than 339 million people had Asthma globally in 2016. It is a common disease among children. The common disease asthma is probably not a single disease, but rather a complex of multiple, separate syndromes that overlap. Most asthma-related deaths occur in low- and lower-middle income countries. According to the World Health Organization (WHO) estimates, there were 417,918 deaths due to asthma at the global level and 24.8 million DALYS attributable to Asthma in in 2016. The WHO has estimated that the economic costs associated with asthma have exceeded those of TB and HIV/AIDS combined, and the Global Initiative for Asthma Program forecasted the number of asthma patients to grow globally to greater than 400 million by the year 2025. Since its first description by Hippocrates, asthma remains a treatable yet incurable disease. It is now clear that asthma is a complex syndrome with variable severity, natural history and response to treatment In Namibia a prevalence of Asthma of 11.2 % has been reported in adult populations. The increase in asthmatic episodes, morbidity and mortality among populations in Africa, Latin America and parts of Asia is a rising public health concern. The development of novel asthma phenotyping & endo typing plus better classification of patients using machine learning and big data have markedly improved asthma treatment outcomes in both children and Adults. Several research groups have developed cluster analyses of phenotypes in severe asthma. These clusters support the importance of disease heterogeneity in asthma and suggest differences in pathophysiologic mechanisms that define these clusters. Precision medicine is "an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person.
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Galowitz, Paula. "The Opportunities and Challenges of an Interdisciplinary Clinic." International Journal of Clinical Legal Education 18 (July 8, 2014): 165. http://dx.doi.org/10.19164/ijcle.v18i0.5.
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<p>Law school clinics in many countries increasingly provide the major opportunities that law students have to engage in interdisciplinary collaborations with other professionals. The collaboration may be with a wide range of professionals, such as: doctors and medical students; social workers and social work students; business school students; engineering faculty and students including biomedical engineering students; nursing students; and experts in public health, education, mental health or palliative care. It can occur in diverse contexts or targeted to specific populations, such as children, the elderly, victims of domestic violence or low-income business owners.</p><p>Some examples of these interdisciplinary clinics illustrate their variety. Clinical legal education initiatives in South Africa, Thailand and Ukraine promoted public health through programs that partnered with the Law and Health Initiative of the Open Society Institute’s Public Health Programs. In South Africa, palliative care was integrated with legal services; law students worked with staff at a hospice association to conduct workshops on wills, debts and family law for hospice caregivers. In Ukraine a Medical Law Clinic was started to advise and represent clients; in Thailand a law clinic wrote an HIV/AIDS Community Legal Education Manual, collaborated with organizations working on health and human rights issues to discuss harm reduction and incarceration, and implemented community education programs in prisons, detention centers and community centers. At Palacky University in the Czech Republic a new Patient’s Rights Legal Clinic, which prepares students to give legal advice, is taught by lecturers of the medical faculty and lawyers from a human rights non-profit. A clinic in the United States provides business planning and legal advice to small businesses; law and business students collaborate to assist with community economic development. Another United States clinic combines students in law, business, medicine, social work, biomedical engineering, and arts and sciences in a collaboration focused on intellectual property and business formation, with an emphasis on biodiversity and agricultural-biotechnology innovations.</p>
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Mishra, Santosh Kumar. "Addressing reproductive and maternal health in Latin America and the caribbean – initiatives underway." Obstetrics & Gynecology International Journal 9, no. 6 (November 16, 2018): 423–30. http://dx.doi.org/10.15406/ogij.2018.09.00379.
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Increased focus on reproductive and maternal health not only benefits the mother and her newborn child, but it can also strengthen families and communities. Family planning allows women to space their pregnancies, and can delay pregnancy in younger women, who often face an increased risk of complications. Ensuring safe pregnancies and childbirth is critical. Maternal deaths are the second biggest killer of women of reproductive age. Despite the increase in contraceptive use over the years, many women still do not have access to modern contraceptive methods. In sub-Saharan Africa, e.g., one in four women who wish to delay or stop childbearing does not use any family planning method. In Latin America and the Caribbean (LAC: focal point of the present paper), 62% of women aged 15-49 want to avoid a pregnancy; however, 22% of these women (23 million in 2014) are not using an effective contraceptive method. Such women (defined as having an “unmet need” for family planning/modern contraception), account for a disproportionately high 75% of all unintended pregnancies in the region. This situation places young people (especially those in the poorest and most marginalized communities) at high risk for HIV/AIDS infection and unwanted pregnancy. Presently, many reproductive and maternal health programs (both in ‘governmental’ as well as ‘non-governmental/private’ sectors) are on move in LAC. Such programs provide reproductive and maternal health services to those in need. One such initiative is: “Family Care International (FCI) program of the Management Sciences for Health (MSH” which advocates for improved sexual, reproductive, maternal, newborn, and adolescent health and rights in LAC. This writing aims at outlining the framework of working mechanism within which the FCI program functions in LAC. Data used in this work are ‘qualitative’ and ‘secondary’ in nature and method of data analysis is ‘descriptive’; with focus on “case study” approach.
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Masenya, Madipoane. "Wa re o Bona e Hlot�a, wa e Namet�a Thaba! Bibele, Basadi ba Maafrika ba Afrika-Borwa le HIV le AIDS." Verbum et Ecclesia 31, no. 1 (March 29, 2010). http://dx.doi.org/10.4102/ve.v31i1.412.
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The question of the history of the reception of the Christian Bible in South Africa particularly by African- South Africans has not been a smooth ride. It was part of a bigger package that included among others, the importation of European patriarchy onto African soil, the land grabbing exercise which resulted in among others, the impoverishment of African peoples and, the emasculation of the African man. The latter in turn led to the intensification of patriarchy within the average African family. The preceding situation, was not helpful to the context and/or situation of African women who were already then, at the bottom of the patriarchal ladder, because, as can be expected, within the context of the Black church and theology then, little if any except for a handful of liberation theologians and members of some ecumenical bodies, was done to make the theology propagated then, relevant to pertinent issues which affected the lives of Black people.Given the historical marginalisation of women in the Bible and Theology, not only in South Africa, but also globally, it becomes obvious that even in our context, mainstream theology and biblical hermeneutics left issues pertaining to gender justice basically untouched. It is no wonder, as we will argue in this paper, that given that already vulnerable situation into which African women have been thrown into by the preceding factors as well as by how the Bible continues to be used in our HIV and AIDS contexts, their situation may be succinctly captured as that of a limping animal that has been made to climb the mountain! The Northern Sotho proverb or saying: Wa re o bona e hlot�a, wa e namet�a thaba (while limping, you let it climb the mountain) simply means that a certain situation is being aggravated (by an external factor). The present article will use the preceding proverb as a hermeneutical lens through which to analyse the reception of the Bible by African women in the HIV and AIDS context of South Africa.
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Chang, Charlotte A., Seema Thakore Meloni, Geoffrey Eisen, Beth Chaplin, Patrick Akande, Prosper Okonkwo, Holly E. Rawizza, Eric Tchetgen Tchetgen, and Phyllis J. Kanki. "Tuberculosis Incidence and Risk Factors Among Human Immunodeficiency Virus (HIV)-Infected Adults Receiving Antiretroviral Therapy in a Large HIV Program in Nigeria." Open Forum Infectious Diseases 2, no. 4 (2015). http://dx.doi.org/10.1093/ofid/ofv154.
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Abstract Background. Despite the benefits of antiretroviral therapy (ART), tuberculosis (TB) is the leading cause of mortality among human immunodeficiency virus (HIV)-infected persons in Africa. Nigeria bears the highest TB burden in Africa and second highest HIV burden globally. This long-term multicenter study aimed to determine the incidence rate and predictors of TB in adults in the Harvard/AIDS Prevention Initiative in Nigeria (APIN) and President's Emergency Plan for AIDS Relief (PEPFAR) Nigeria ART program. Methods. This retrospective evaluation used data collected from 2004 to 2012 through the Harvard/APIN PEPFAR program. Risk factors for incident TB were determined using multivariate Cox proportional hazards regression with time-dependent covariates. Results. Of 50 320 adults enrolled from 2005 to 2010, 11 092 (22%) had laboratory-confirmed active TB disease at ART initiation, and 2021 (4%) developed active TB after commencing ART. During 78 228 total person-years (PY) of follow-up, the TB incidence rate was 25.8 cases per 1000 PY (95% confidence interval [CI], 24.7–27.0) overall, and it decreased significantly both with duration on ART and calendar year. Risk factors at ART initiation for incident TB included the following: earlier ART enrollment year, tenofovir-containing initial ART regimen, and World Health Organization clinical stage above 1. Time-updated risk factors included the following: low body mass index, low CD4+ cell count, unsuppressed viral load, anemia, and ART adherence below 80%. Conclusions. The rate of incident TB decreased with longer duration on ART and over the program years. The strongest TB risk factors were time-updated clinical markers, reinforcing the importance of consistent clinical and laboratory monitoring of ART patients in prompt diagnosis and treatment of TB and other coinfections.
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Chibanda, Dixon, Melanie Abas, Rosemary Musesengwa, Chris Merritt, Katherine Sorsdahl, Walter Mangezi, Chiwoza Bandawe, et al. "Mental health research capacity building in sub-Saharan Africa: the African Mental Health Research Initiative." Global Mental Health 7 (2020). http://dx.doi.org/10.1017/gmh.2019.32.
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Abstract Mental, neurological and substance use (MNS) disorders are a leading, but neglected, cause of morbidity and mortality in sub-Saharan Africa. The treatment gap for MNS is vast with only 10% of people with MNS disorders in low-income countries accessing evidence-based treatments. Reasons for this include low awareness of the burden of MNS disorders and limited evidence to support development, adaptation and implementation of effective and feasible treatments. The overall goal of the African Mental Health Research Initiative (AMARI) is to build an African-led network of MNS researchers in Ethiopia, Malawi, South Africa and Zimbabwe, who are equipped to lead high quality mental health research programs that meet the needs of their countries, and to establish a sustainable career pipeline for these researchers with an emphasis on integrating MNS research into existing programs such as HIV/AIDS. This paper describes the process leading to the development of AMARI's objectives through a theory of change workshop, successes and challenges that have been faced by the consortium in the last 4 years, and the future role that AMARI could play in further building MNS research capacity by brining on board more institutions from low- and middle-income countries with an emphasis on developing an evidence-based training curriculum and a research-driven care service.
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Geneau, R., M. Alary, N. Andersson, E. Katongole-Mbidde, R. O'Neil, T. Wilson, and D. Zannou. "P06-05. Building capacity for HIV/AIDS prevention trials in Africa: Evidence from three projects supported by the Global Health Research Initiative." Retrovirology 6, S3 (October 2009). http://dx.doi.org/10.1186/1742-4690-6-s3-p94.
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Jackson-Gibson, Maya, Ashley Uzoamaka Ezema, Wicklife Orero, Irene Were, Ramael Osasogie Ohiomoba, Patrick Owuor Mbullo, and Lisa Ruth Hirschhorn. "Facilitators and barriers to HIV pre-exposure prophylaxis (PrEP) uptake through a community-based intervention strategy among adolescent girls and young women in Seme Sub-County, Kisumu, Kenya." BMC Public Health 21, no. 1 (July 1, 2021). http://dx.doi.org/10.1186/s12889-021-11335-1.
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Abstract Background While the introduction of HIV Pre-Exposure Prophylaxis (PrEP) as an HIV prevention strategy has allowed women to exercise more control over the reduction of HIV transmission rates, adolescent girls and young women in Sub-Saharan Africa continue to experience higher rates of HIV infections and bear the greatest disease burden. Understanding progress in PrEP uptake among adolescent girls and young women would enhance risk reduction in this vulnerable population. The Determined, Resilient, AIDS-Free, Mentored and Safe women (DREAMS) Initiative plays a key role in this risk reduction strategy. Methods We performed a qualitative study to explore facilitators and barriers to PrEP implementation and assess factors effecting initiation and persistence on PrEP among adolescent girls and young women enrolled in the DREAMS Initiative at Pamoja Community Based Organization in Kisumu, Kenya. We conducted key informant interviews (n = 15) with Pamoja Community Based Organization staff, health care providers and community leaders. Additionally, we conducted focus group discussions with young women receiving PrEP and peer mentors (n = 40). We performed a directed content analysis using the Consolidated Framework for Implementation Research to organize the identified facilitators and barriers. Results We found that the use of the safe space model, decentralization of PrEP support and delivery, peer mentors, effective linkage to local health care facilities, the sensitization of parents and male sexual partners, disclosure of PrEP use by beneficiaries, active stakeholder involvement and community engagement were among some of the facilitators to PrEP uptake. Barriers to PrEP implementation, initiation and persistence included stigma associated with the use of anti-retroviral drugs, drug side effects, frequent relocation of beneficiaries, limited resources for routine screening and medication monitoring, and a limited number of qualified health care workers for PrEP distribution and administration. Conclusion Overall, the community roll-out of PrEP within the DREAMS Initiative was successful due to a number of key facilitating factors, which ultimately led to successful PrEP implementation, increased PrEP initiation and enhanced persistence among adolescent girls and young women. The identified barriers should be addressed so that a larger scale-up of PrEP roll-out is possible in the future.
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Bahati, Prince, Zablon Omungo, Bonnie Bender, and Josea Rono. "Regulatory and Ethical Approval Timelines for HIV Vaccine Studies: An Analysis of International AIDS Vaccine Initiative (IAVI) Sponsored Studies in East and Southern Africa." Journal of AIDS & Clinical Research 08, no. 03 (2017). http://dx.doi.org/10.4172/2155-6113.1000676.
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Matzopoulos, R., A. Cois, C. Probst, C. D. H. Parry, N. Vellios, K. Sorsdahl, J. D. Joubert, V. Pillay-van Wyk, D. Bradshaw, and R. Pacella. "Estimating the changing burden of disease attributable to alcohol use in South Africa for 2000, 2006 and 2012." South African Medical Journal, September 30, 2022, 662–75. http://dx.doi.org/10.7196/samj.2022.v112i8b.16487.
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Background. Alcohol use was one of the leading contributors to South Africa (SA)’s disease burden in 2000, accounting for 7% of deaths and disability-adjusted life years (DALYs) in the first South African Comparative Risk Assessment Study (SACRA1). Since then, patterns of alcohol use have changed, as has the epidemiological evidence pertaining to the role of alcohol as a risk factor for infectious diseases, most notably HIV/AIDS and tuberculosis (TB).Objectives. To estimate the burden of disease attributable to alcohol use by sex and age group in SA in 2000, 2006 and 2012.Methods. The analysis follows the World Health Organization (WHO)’s comparative risk assessment methodology. Population attributable fractions (PAFs) were calculated from modelled exposure estimated from a systematic assessment and synthesis of 17 nationally representative surveys and relative risks based on the global review by the International Model of Alcohol Harms and Policies. PAFs were applied to the burden of disease estimates from the revised second South African National Burden of Disease Study (SANBD2) to calculate the alcohol-attributable burden for deaths and DALYs for 2000, 2006 and 2012. We quantified the uncertainty by observing the posterior distribution of the estimated prevalence of drinkers and mean use among adult drinkers (≥15 years old) in a Bayesian model. We assumed no uncertainty in the outcome measures.Results. The alcohol-attributable disease burden decreased from 2000 to 2012 after peaking in 2006, owing to shifts in the disease burden, particularly infectious disease and injuries, and changes in drinking patterns. In 2012, alcohol-attributable harm accounted for an estimated 7.1% (95% uncertainty interval (UI) 6.6 - 7.6) of all deaths and 5.6% (95% UI 5.3 - 6.0) of all DALYs. Attributable deaths were split three ways fairly evenly across major disease categories: infectious diseases (36.4%), non-communicable diseases (32.4%) and injuries (31.2%). Top rankings for alcohol-attributable DALYs for specific causes were TB (22.6%), HIV/AIDS (16.0%), road traffic injuries (15.9%), interpersonal violence (12.8%), cardiovascular disease (11.1%), cancer and cirrhosis (both 4%). Alcohol remains an important contributor to the overall disease burden, ranking fifth in terms of deaths and DALYs.Conclusion. Although reducing overall alcohol use will decrease the burden of disease at a societal level, alcohol harm reduction strategies in SA should prioritise evidence-based interventions to change drinking patterns. Frequent heavy episodic (i.e. binge) drinking accounts for the unusually large share of injuries and infectious diseases in the alcohol-attributable burden of disease profile. Interventions should focus on the distal causes of heavy drinking by focusing on strategies recommended by the WHO’s SAFER initiative.
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George, Cindy, Mark Woodward, Ikechi Okpechi, and Andre Kengne. "P0769ESTABLISHING AN AFRICAN NETWORK FOR CHRONIC KIDNEY DISEASE EPIDEMIOLOGY: THE CKD-AFRICA COLLABORATION." Nephrology Dialysis Transplantation 35, Supplement_3 (June 1, 2020). http://dx.doi.org/10.1093/ndt/gfaa144.p0769.
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Abstract Background and Aims Chronic kidney disease (CKD) is a global public health problem, disproportionately affecting individuals of African ancestry. Unfortunately, due to the lack of data in various African countries or the limitations of available data, the true magnitude of CKD on the continent is still unknown. Although there has been an increase in the number of reports on CKD prevalence in recent years, up to now there has been no coordinated effort to provide reliable estimates to adequately support the health service and policy solutions to address the adverse consequences of CKD in Africa. The Chronic Kidney Disease in Africa Collaboration (CKD-AFRICA Collaboration), which is an initiative of the South African Medical Research Council, seeks to address this issue by collating data, at individual participant data (IPD) level, from existing African studies. Thus, the main aims for establishing this platform are, (1) to utilize the available data from all relevant prevalence studies of CKD, to provide an updated and comprehensive synthesis on the burden of CKD in Africa, and (2) to bring together active investigators in the field of CKD epidemiology and prevention, by providing a platform to plan, in a more coordinated way, future observational and interventional studies on CKD across the continent. Method To establish the CKD-AFRICA Collaboration as a continental resource, a stepwise approach was utilized, which included, 1) the identification of data sources through various systematic literature searches and contacting health agencies to access publicly available population-based measurement surveys; 2) establishing a database platform, by inviting active CKD research groups to contribute data on CKD at IPD level; 3) data processing and quality control and 4) piloting the consortium, by using the data from existing studies to determine the prevalence of CKD in the African adult population, by two-stage IPD meta-analysis. Results Through extensive systematic literature searches, 134 potential collaborators were identified. These included studies conducted in general adult populations and high-risk sub-populations, such as those with HIV/AIDS, hypertension and diabetes. Of those identified, 101 principal investigators (PIs) were contacted, via email, to gauge their interest in collaborating in the consortium, as 33 PIs lacked contact information. Of the 101 PIs, 42 responded positively to the call and have agreed to participate in the consortium, spanning 12 African countries, namely Ghana, Kenya, Nigeria, Burundi, Cameroon, Maputo, Sudan, South Africa, Egypt, Uganda, Senegal and Tanzania (Figure 1). To date, the consortium has potential access to 27,346 IPD, with 11,810 IPD already received. Conclusion The strength of this Consortium has far-reaching potential for Africa. Indeed, by harnessing IPD from numerous African studies, important research questions can be explored, and by connecting active CKD researchers, this platform could aid a more coordinated way of developing future observational and interventional studies on CKD in Africa. The research obtained from this collaboration will therefore permit the exploration in understanding the diversity of clinical manifestations of CKD in Africa.
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Holtorf, Anke-Peggy, Debjani Mueller, M. Sharmila A. Sousa, Lauren Pretorius, Kalman Emry Wijaya, Sylvester Adeyemi, and Dipen Ankleshwaria. "Pilot approach to analyzing patient and citizen involvement in health technology assessment in four diverse low- and middle-income countries." International Journal of Technology Assessment in Health Care 37, no. 1 (2021). http://dx.doi.org/10.1017/s0266462320002263.
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Abstract Background In low- and middle-income countries (LMICs) striving to achieve universal health coverage, the involvement of different stakeholders in formal or informal ways in health technology assessment (HTA) must be culturally and socially relevant and acceptable. Challenges may be different from those seen in high-income countries. In this article, we aimed to pilot a questionnaire for uncovering the context-related aspects of patient and citizen involvement (PCI) in LMICs, collecting experiences encountered with PCI, and identifying opportunities for patients and citizens toward contributing to local decision- and policy-making processes related to health technologies. Methods Through a collaborative, international multi-stakeholder initiative, a questionnaire was developed for describing each LMIC's healthcare system context and the emergence of opportunities for PCI relating to HTA. The questionnaire was piloted in the first set of countries (Brazil, Indonesia, Nigeria, and South Africa). Results The questionnaire was successfully applied across four diverse LMICs, which are at different stages of using HTA to inform decision making. Only in Brazil, formal ways of PCI have been defined. In the other countries, there is informal influence that is contingent upon the engagement level of patient and citizen advocacy groups (PCAGs), usually strongest in areas such as HIV/AIDS, TB, oncology, or rare diseases. Conclusions The questionnaire can be used to analyze the options for patients and citizens to participate in HTA or healthcare decision making. It will be rolled out to more LMICs to describe the requirements and opportunities for PCI in the context of LMICs and to identify possible routes and methodologies for devising a more systematic and formalized PCI in LMICs.
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Kinuthia, Rosemary, Andre Verani, Jessica Gross, Rose Kiriinya, Kenneth Hepburn, Jackson Kioko, Agnes Langat, Abraham Katana, Agnes Waudo, and Martha Rogers. "The development of task sharing policy and guidelines in Kenya." Human Resources for Health 20, no. 1 (July 29, 2022). http://dx.doi.org/10.1186/s12960-022-00751-y.
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Abstract Background The global critical shortage of health workers prevents expansion of healthcare services and universal health coverage. Like most countries in sub-Saharan Africa, Kenya’s healthcare workforce density of 13.8 health workers per 10,000 population falls below the World Health Organization (WHO) recommendation of at least 44.5 doctors, nurses, and midwives per 10,000 population. In response to the health worker shortage, the WHO recommends task sharing, a strategy that can increase access to quality health services. To improve the utilization of human and financial health resources in Kenya for HIV and other essential health services, the Kenya Ministry of Health (MOH) in collaboration with various institutions developed national task sharing policy and guidelines (TSP). To advance task sharing, this article describes the process of developing, adopting, and implementing the Kenya TSP. Case presentation The development and approval of Kenya’s TSP occurred from February 2015 to May 2017. The U.S. Centers for Disease Control and Prevention (CDC) allocated funding to Emory University through the United States President’s Emergency Plan for AIDS Relief (PEPFAR) Advancing Children’s Treatment initiative. After obtaining support from leadership in Kenya’s MOH and health professional institutions, the TSP team conducted a desk review of policies, guidelines, scopes of practice, task analyses, grey literature, and peer-reviewed research. Subsequently, a Policy Advisory Committee was established to guide the process and worked collaboratively to form technical working groups that arrived at consensus and drafted the policy. The collaborative, multidisciplinary process led to the identification of gaps in service delivery resulting from health workforce shortages. This facilitated the development of the Kenya TSP, which provides a general orientation of task sharing in Kenya. The guidelines list priority tasks for sharing by various cadres as informed by evidence, such as HIV testing and counseling tasks. The TSP documents were disseminated to all county healthcare facilities in Kenya, yet implementation was stopped by order of the judiciary in 2019 after a legal challenge from an association of medical laboratorians. Conclusions Task sharing may increase access to healthcare services in resource-limited settings. To advance task sharing, TSP and clinical practice could be harmonized, and necessary adjustments made to other policies that regulate practice (e.g., scopes of practice). Revisions to pre-service training curricula could be conducted to ensure health professionals have the requisite competencies to perform shared tasks. Monitoring and evaluation can help ensure that task sharing is implemented appropriately to ensure quality outcomes.