Research Articles (Family Medicine)

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Insights into the value of the market for cocaine, heroin and methamphetamine in South Africa
(LSE Press, 2024) Scheibe, Andrew; Shelly, Shaun; Stowe, M.J.
The illicit drug trade generates billions of dollars and sustains transnational criminal organisations. Drug markets can destabilise governance and undermine development. Data indicate increasing drug use in South Africa. However, information on the size and value of the drug market is limited. This is the first study to estimate the market value of cocaine, heroin and methamphetamine in South Africa. People who use drugs were meaningfully involved in all aspects of implementation. We used focus group discussions, ethnographic mapping, brief interviews, and the Delphi method to estimate the number of users, volumes consumed, and price for each drug in South Africa in 2020. Nationally, we estimated there to be: 400,000 people who use heroin (probability range (PR) 215,000–425,000) consuming 146.00 tonnes (PR 78.48–155.13) with a value of US$1,898.00 million (PR US$1,020.18–US$2,016.63); 350,000 people who use cocaine (PR 250,000–475,000) consuming 18.77 tonnes (PR 13.41–25.47) with a market value of US$1,219.86 million (PR 871.33–1,655.52) and 290,000 people who use methamphetamine (PR 225,000–365,000) consuming 60.19 tonnes (PR 6.58–10.68) and a market value of US$782.51 million (PR 607.12–984.88). The combined value was calculated at US$3.5 billion. Findings can be used to stimulate engagement to reform drug policy and approaches to mitigate the impact of the illicit drug trade. Additional studies that include people who use drugs in research design and implementation are needed to improve our understanding of drug markets.
The oral health status and anthropometric measurements of children at early childhood development centers in an informal settlement in Pretoria, South Africa
(Jaypee Brothers Medical Publishers, 2024) Bhayat, Ahmed; Madiba, Thomas Khomotjo; Beeforth, Marion; Nkambule, Ntombizodwa Rosemary; ahmed.bhayat@up.ac.za
OBJECTIVES : Early childhood caries (ECC) continue to increase, especially among low socioeconomic communities. This study was conducted in an informal settlement comprising mostly foreigners who have settled in the area. Given the limited dental and medical services available to these communities, this study aimed to determine the dental and medical disease profile of these inhabitants. The objective was to determine the oral health status and the body mass index (BMI) of children attending crèches in an informal settlement. MATERIALS AND METHODS : Oral health data, including dental caries (DC), soft tissue lesions, fluorosis, erosion, and trauma, were recorded using the World Health Organization (WHO) recommended methods. The examiners were calibrated, and all examinations took place at the crèches under natural sunlight. The BMI was calculated by a team of dieticians who were blinded to the oral health status. The height and weight were measured by calibrated examiners under standardized conditions. RESULTS : There were a total of 169 participants; the mean age was 4.02 years (±1.13; 1–7) and there was an equal distribution of males and females (49.7% females and 49.3% males). The prevalence of DC was 39.1%, with 19% having 4 or more carious teeth. The mean decayed, missing, and filled teeth (dmft) and plaque scores [Simplified Oral Hygiene Index (OHI-S)] were 1.58 (±2.70) and 0.65 (±0.43), respectively, and the mean dmft score increased with increasing age. The mean d component contributed 99% of the total mean dmft score (1.56). The mean BMI was 15.44, and this decreased significantly (p = 0.009) while the OHI increased significantly (p < 0.001) as the number of carious teeth increased. CONCLUSION : The prevalence of caries was relatively high, and those with caries had multiple decayed teeth. The d component contributed almost 100% to the mean score, indicating a lack of access to dental care. The mean BMI score was inversely proportional to the number of carious teeth, which could imply that those with caries had difficulty eating.
An audit of completeness of Road to Health Booklet at a community health centre in South Africa
(AOSIS, 2024-12) Machimana, Pfunzo; Nyalunga, Suzan L.N.; Madela-Mntla, Edith; Nzaumvila, Doudou
BACKGROUND: For continuity and quality of care, accurate record-keeping is crucial. Complete care is facilitated by completing a child’s Road to Health Booklet (RTHB) as well as prompt interpretation and appropriate action. This could result in a decrease in child morbidity and mortality. AIM: The study was aimed at assessing the completeness of the RTHB of children younger than 5 years. SETTING: Temba Community Health Centre (CHC), Tshwane District, South Africa. METHODS: A cross-sectional study was conducted using a data collection sheet adopted from previous studies. RESULTS: Children less than 1-year-old accounted for 70.2% of the 255 RTHBs. The mean ± s.d. age was 11.5 ±10.76 months. The study finding showed no section was 100% fully completed. Of the 255 records studied, 38 (14.9%) human immunodeficiency virus (HIV)-exposed babies were recorded at birth, 39.5% were negative at 6 weeks and 60.5% were not recorded. Ninety-one (35.7%) children were unexposed. The HIV status of 126 (49.4%) children was not recorded. Sixty-six per cent (66%) of recorded maternal syphilis was negative. Immunisations, weight-for-age, neonatal information, and details of the family and child were fully completed in 80% of the booklets. Developmental screening was 17.2% completed, and oral health was 1.6% partially completed. The overall completeness was 40.3%. CONCLUSION: The completeness of RTHBs was found to be suboptimal. CONTRIBUTION: The present study’s findings should serve as a reminder that healthcare practitioners must complete RTHBs in their totality in order to improve continuity and care quality, as the results indicated that RTHB completion was below ideal.
Feasibility of implementing viral hepatitis services into a correctional service facility in Cape Town, South Africa
(Elsevier, 2025-03) Scheibe, Andrew; Steingo, Joel; Grace, Gaynor; Savva, Helen; Sonderup, Mark; Hausler, Harry; Spearman, C. Wendy
BACKGROUND : Hepatitis B virus (HBV) and hepatitis C virus (HCV) are estimated to be of the most prevalent infectious diseases in correctional settings worldwide. However, viral hepatitis services have not been routinely integrated into South African correctional facilities. We aimed to assess prevalence of HBV infection and HCV infection among people accessing HIV services and assess the feasibility of viral hepatitis service integration in a South African correctional centre. METHODS : Voluntarily participating people in a correctional services facility were offered free hepatitis B surface antigen (HBsAg) and anti-HCV point-of-care testing in addition to routine HIV testing and treatment services on a first-come, first-served basis during June 2021–March 2022. Off-site laboratory testing (HBV and HCV molecular testing and non-invasive liver fibrosis staging) and screening for hepatocellular carcinoma informed further management. A general practitioner at the facility managed participants, with virtual support from hepatologists. Data on age and history of injecting was collected and point-of-care and laboratory results were recorded. Data were analysed using descriptive statistics. RESULTS : The median age of the 765 people who participated was 32.5 years (IQR 27.5 – 38.2), with 2.2% (17/765) reporting having ever injected a drug. The sample prevalence was 3.9% (30/765) for HBV infection, 0.5% (3/665) for HCV infection, and 1.2% (9/765) for HIV-HBV coinfection. Thirty people had reactive HBsAg point-of-care tests. Among those with reactive HBsAg point-of-care tests 90.0% (27/30) received work-up, among whom 48.1% (13/27) were monitored, 44.4% (12/27) were placed on treatment and two people were released before a management plan could be finalised. Of those treated 33.3% (4/12) started tenofovir/emtricitabine and 66.7% (8/12) antiretroviral therapy. Of the eligible participants, 27.3% (201/735) received at least one hepatitis B vaccine dose and 26.9% (54/201) received three doses. All three participants who had confirmed HCV infection were started on direct-acting antivirals. Of the two completing treatment one achieved sustained virological response at 12 weeks (SVR12), one person was released before SVR12 was done. One person was lost to follow-up. No clinical adverse events were reported. CONCLUSION : There was a notable viral hepatitis burden among people in this correctional centre and integration of viral hepatitis services into the existing HIV services was acceptable and feasible. Further efforts to sustain and expand access to viral hepatitis services in South African correctional centres could catalyse national viral hepatitis elimination efforts.
Giving adolescent girls and young women a foothold : economic strengthening as a key protection strategy against HIV infection in South Africa
(Taylor and Francis, 2024-12-19) Hartnack, Andrew; Mcloughlin, Jenny; Pretorius, Anje; Hausler, Harry
This paper focused on the prevention of HIV transmission for adolescent girls and young women (AGYW), through a layered approach which included economic strengthening as a core strategy, especially for the most vulnerable. Based on multi-year data in KwaZulu-Natal, South Africa, we assessed the outcomes of an economic strengthening model developed by TB HIV Care (THC) in the Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) HIV prevention programme. The methods used are primarily qualitative. In 2021, 2022, and 2024 DREAMS implementation staff (n = 72) and economic strengthening beneficiaries (n = 73) from four districts were interviewed on the dynamics of the model and its emerging outcomes. The qualitative data were supplemented by monitoring data. The study results showed that, while longer-term outcomes for the beneficiaries were unclear, the short and medium-term benefits of economic strengthening activities for vulnerable AGYW were highly promising. Not only did beneficiaries gain valuable technical and life skills through training, but they showed increased confidence and hope for the future, and a new sense of empowerment. They also experienced social asset building and an increase in their social, economic, and emotional efficacy. Importantly, beneficiaries also showed signs of behaviour change, away from risky behaviours towards protective ones. The paper concludes that layered economic strengthening initiatives targeted towards those most at risk AGYW, is an important pillar of efforts to reduce HIV infection; however, challenges around taking such initiatives to scale and tracking long-term outcomes remain
HIV incidence and factors associated with HIV risk among people who inject drugs engaged with harm-reduction programmes in four provinces in South Africa : a retrospective cohort study
(Elsevier, 2024-12) Artenie, Adelina; Perry, Rachel; Mahaso, Memory; Jankie, Thenjiwe; McNaughton, Anna L.; Stone, Jack; Vickerman, Peter; Scheibe, Andrew
BACKGROUND : HIV incidence among people who inject drugs in South Africa has never been estimated. We aimed to estimate HIV incidence and associations with risk and protective factors among people who inject drugs engaged with harm-reduction services. METHODS : For this retrospective cohort study we used programmatic data collected from April 1, 2019, to March 30, 2022, by the Networking HIV and AIDS Community of South Africa, which offers harm-reduction services and HIV testing to people who inject drugs. During this 3-year period, services were delivered through drop-in centres and outreach in four South African provinces: Gauteng, KwaZulu-Natal, Western Cape, and Eastern Cape. Our cohort comprised people who inject drugs who did not self-report being HIV positive, were HIV negative at first testing, and had at least one follow-up test. Data were collected by outreach teams. We estimated HIV incidence, assuming seroconversions occurred at the midpoint between the last negative test and first positive test. We assessed associations between HIV seroconversion risk and several factors with Cox regression models, including sociodemographic characteristics, primary drugs used, uptake of interventions (ie, number of harm-reduction packs and opioid agonist treatment [OAT]), and HIV testing interval. FINDINGS : Of 31 182 people who inject drugs accessing harm-reduction services, 20 955 (including 3409 self-reporting being HIV positive) were not tested for HIV. Of 10 227 people who tested at least once, 8152 were HIV negative at first test and of these, 2402 had at least two tests and formed the study cohort. Overall, 283 (11·8%) people who inject drugs acquired HIV over 2306·1 person-years. HIV incidence was higher in Gauteng (16·7 per 100 person-years; 95% CI 14·5–19·1) and KwaZulu-Natal (14·9 per 100 person-years; 11·3–19·3), than in the Eastern Cape (5·0 per 100 person-years; 2·3–9·6) and Western Cape (3·2 per 100 person-years; 1·9–4·9). In multivariable Cox models, HIV acquisition risk varied by race, primary drugs used, and interval between HIV tests. Additionally, people who injected drugs and received OAT in the past year had lower HIV risk (adjusted hazard ratio 0·48; 95% CI 0·22–1·03) than people who did not receive OAT, although the 95% CI was wide and crossed the null. INTERPRETATION : Our study highlights a pressing need for scale-up of HIV prevention strategies, particularly opioid agonist treatment, for people who inject drugs in South Africa. Dedicated investments are needed to develop monitoring systems for HIV incidence, risk behaviours, and uptake of interventions to ensure effective and equitable programmes.
E-cigarettes and harm reduction : a view from sub-Saharan Africa
(BMJ Publishing Group, 2024-07) Egbe, Catherine; Khan, Arshima; Scheibe, Andrew; Ayo-Yusuf, Olalekan Abdulwahab
No abstract available.
Community members’ perceptions of community health workers in Melusi, Tshwane, South Africa
(AOSIS, 2024-09) Madzivhandila, Rebaone K.; Ngcobo, Sanele; sanele.ngcobo@up.ac.za
BACKGROUND: Community health workers (CHWs) play an important role in health promotion through health campaigns and home visits, and provide linkage to care and support patient management. In the informal settlements, CHWs identify health challenges and help residents to access healthcare facilities. AIM: This study aimed to explore the perception held by the community members regarding CHWs’ contribution to health promotion in Melusi informal settlements within the Tshwane district. SETTING: The study was conducted in Melusi informal settlement situated in Pretoria west in South Africa. METHODS: Descriptive exploratory qualitative research methods were used, with open and closed-ended questions during individual interview sessions. Participants were purposefully selected in collaborating with the community leaders and using CHWs’ data to identify individuals with direct interaction with CHWs. RESULTS: Participants praised CHWs’ communication skills, engagement strategies, and ability to provide valuable health services. Community members expected CHWs to provide healthcare services, educational support, advocacy for health issues and guidance on well-being. Barriers such as community resistance, a lack of privacy and difficulties in reaching households were noticed. However, CHWs were commended for their impact on well-being, offering health services, emergency support, food assistance and improved healthcare accessibility. CONCLUSION: The study indicates that community members have positive perceptions of CHWs. This highlights the significant role of CHWs in promoting health and well-being within the community. CONTRIBUTION: This study provides insights into community perceptions of CHWs in informal settlements, emphasising their impact on community well-being. It provides a basis for their effectiveness and support in delivering health services in the informal settlement.
Contextual factors influencing implementation of HIV treatment support strategies for female sex workers living with HIV in South Africa : a qualitative analysis using the Consolidated Framework for Implementation Research
(Lippincott Williams and Wilkins, 2024-11) Comins, Carly A.; Mcingana, Mfezi; Genberg, Becky; Mulumba, Ntambue; Mishra, Sharmistha; Phetlhu, Deliwe R.; Shipp, Lillian; Steingo, Joel; Hausler, Harry; Baral, Stefan D.; Schwartz, Sheree R.
BACKGROUND : Female sex workers (FSWs) face a confluence of multilevel barriers to HIV care. In South Africa, 63% of FSWs are living with HIV and <40% are virally suppressed. The objective of this analysis was to identify implementation determinants of 2 HIV treatment support strategies. METHODS : The Siyaphambili trial tested a decentralized treatment provision and an individualized case management strategy aimed to support FSWs living with unsuppressed HIV viral loads. We identified a nested sample of trial participants using maximum variation sampling (n = 36) as well as a purposively selected sample of implementors (n = 12). We used semistructured interview guides, developed using the Consolidated Framework for Implementation Research (CFIR) and deductively coded the transcripts using CFIR, systematically assessing the strength and valence of implementation. We compared construct ratings to determine whether any constructs distinguished implementation across strategies. RESULTS : Across 3 CFIR domains (innovation characteristics, inner setting, and outer setting), 12 constructs emerged as facilitating, hindering, or having mixed effects on strategy implementation. The relative advantage, design, adaptability, and complexity constructs of the innovation characteristics and the work infrastructure construct of the inner setting were strongly influential (±2 or +2). While the majority of construct valence and strength rating (9–12) were not distinguishing across strategies, we observed 3 weakly distinguishing CFIR constructs (relative advantage, complexity, and available resources). CONCLUSIONS : Given the potential benefits of differentiated service delivery strategies, identifying the relative importance of implementation determinants facilitates transparency and evaluation, supporting future strategy design and implementation. Optimizing implementation will support addressing inequities in HIV care and treatment services.
Virtual interprofessional education for the African continent : AFRI-VIPE
(Health and Medical Publishing Group, 2024-06) Showstark, Mary; Wiss, Andrew C.; Joosten-Hagye, Dawn; Sappio, Erin M.; Slusser, Margaret; Cavezza, Renee; Nyathi, Nhlanganiso; Nyoni, C.N.; Filies, Gérard C.; Pattershall‐Geide, J.; Embry, Erin; Zschaebitz, Elke; McGinnis, Patricia; Resnik, Cheryl; An, I.; Delawala, F.; Pitout, Hanlie; Schweickerdt, Louise; Muller, Jana; Africa, L.; Kholvadia, Aayesha; Ntsekhe, T.; Tshotetsi, Lumbani; Ricks, Esmeralda; Biernacki, Pamela
This article details how multiple universities came together in 2019 during the Africa Interprofessional Education Network (AfrIPEN) conference in Nairobi, Kenya, to create an interprofessional, multi-continent, multi-university opportunity to give their students an asynchronous and synchronous virtual interprofessional experience through a programme known as VIPE (virtual interprofessional education). The programme, which was created after the conference, was entitled AFRI-VIPE (Africa virtual interprofessional education). From that conference, four AFRI-VIPE events have been implemented to date. Asynchronous material was created, and synchronous sessions were held that utilised problem-based learning to reinforce the Interprofessional Education Collaborative (IPEC) core competencies. Students’ competency attainment was assessed using the Interprofessional Collaborative Competencies Attainment Survey (ICCAS), and analysis of those data showed significant improvements across all six interprofessional subscales for students at both North American- and African-based institutions, as well as across professional groups. All data were kept anonymous. Challenges experienced during AFRI-VIPE included the difference in time zones, student attrition, connectivity and survey response rates. Through their participation in the VIPE model, students and facilitators from a variety of countries and professions appreciated the opportunity to learn with, from and about other students through exposure to authentic case studies.
Workplace violence in three public sector emergency departments, Gauteng, South Africa : a cross-sectional survey
(Elsevier, 2024-12) Nkadimeng, Mahlako; Engelbrecht, Andreas; Rajan, Suma; dries.engelbrecht@up.ac.za
INTRODUCTION: Workplace violence against health care workers in Emergency Departments (EDs) is a global concern. The purpose of this study was to determine the prevalence and types of workplace violence in EDs. METHODS: a cross-sectional survey was conducted in three public sector hospital EDs in Gauteng, South Africa. A self-administered, standardised online questionnaire developed by the World Health organization was used to collect data between March and November 2022. A total of 65 health care workers which consisted of nurses (24) and doctors (41) participated in the study. RESULTS: The prevalence of workplace violence was 73.8 % with verbal abuse being the most common type at 66 %. Eighty-two percent of the victims did not report the incident. Poor communication and lack of mutual respect among staff and healthcare users contributed to both physical and non-physical workplace violence. CONCLUSION: Workplace violence appears to be a common occurrence in EDs in the hospitals surveyed in Gauteng. It is regarded as a typical incident by respondents, and it is underreported. It has a direct negative impact on health care workers and their working environment and indirectly on patients. Urgent attention from all stakeholders is needed to minimize the prevalence of these incidents.
An ICT-enabled community oriented primary care intervention in mining communities during COVID-19 (2019-2022) : perceived changes in the role and place of community health workers
(BMC, 2024-10) Marcus, Tessa S.; Renkin, Wayne; Malan, A.S.; Moodie, James M.; Mostert, J.; Phote, Z.; Hugo, J.F.M. (Jannie); tessa.marcus@up.ac.za
BACKGROUND: This is a study of service provider perceptions of the place, role and practices of CHWs in a four-year, large-scale private sector funded, public service ICT-enabled COPC intervention with rural and remote mining communities. Like all South African communities, apart from large mining house employees and some contractors, most people use available public healthcare services and private traditional as well as limited allopathic private sector providers. In addition to the limitations of facility centred primary healthcare and a fragmented health care system, the many negative health effects of mining on the communities, go unattended. METHODS: This is a rapid, qualitative pragmatic study. Using site and participation convenience sampling, 37 semi-structured individual or group interviews were conducted with 57 stakeholders from 38 of the 135 intervention PHC facilities. Using a data driven, inductive approach, the results were analysed thematically in terms of perceived changes in the role and place of CHWs. RESULTS: CHWs registered 42 490 households and captured the demographic and social profiles as well as the health status of over 154 910 individuals using AitaHealth™. These data provided healthcare professionals and managers with knowledge about community demographics, at-risk groups and vulnerable individuals. The intervention changed the locational focus of CHW practice and expanded their scope of work and competencies in household comprehensive health education, advice and care. It led to a growth in community and professional confidence in CHWs as trusted members of mining community PHC teams and to more focused and efficient clinic work. CONCLUSION: This ICT-enabled COPC intervention adopted a comprehensive approach to healthcare delivery that started by including CHWs in PHC teams and locating them in communities. Inclusive and systematic continuous learning, clinically-led CHW service support and ICT-enabled information technology engendered trust in CHWs as competent PHC members, and grew community confidence in them and the PHC system as a whole. Although health, care and other professionals and workers valued the changes the intervention brought to their work as well as people’s lives in underserved and vulnerable mining communities, its sustainability is contingent on the vagaries of political will and financial commitment.
Drug use patterns and health problems among people who use drugs in Guinea-Bissau (2022) : a cross-sectional survey using respondent-driven sampling
(Elsevier, 2024-12) Scheibe, Andrew; Teixeira, Andreia; Djaló, Mamadu Aliu; Pereira, Miriam Nascimento; Ribeiro Barreto, Kátia; Ba, Ibrahim; Bird, Lucia; Eligh, Jason
BACKGROUND : Little data exists on the use of cocaine, methamphetamine, tramadol and heroin or related health conditions in Guinea Bissau. We aimed to estimate drug use practices and the prevalence of selected blood-borne infections, depression and population size estimates of people who use injectable drugs in Guinea-Bissau. METHODS : We used respondent-driven sampling to recruit adults who use injectable drugs in this cross sectional survey in three cities (Bissau, Bafatá and Gabú) between July and September 2022. Participants completed an interviewer administered survey enquiring about sociodemographic characteristics, drug use practices and mental health. Rapid diagnostic testing was done for HIV, hepatitis B surface antigen (HBsAg) and hepatitis C antibody (anti-HCV). Data was weighted in RDS-Analyst using self-reported network size and Gile's Sequential Sampling Estimator. Population size estimates were generated using the two point capture-recapture method. RESULTS : Overall, 750 participants were recruited. People who use drugs were estimated to be mostly unemployed males aged between 25 and 49 years. Methamphetamine and crack cocaine were most commonly used. Prevalence of ever injecting ranged from 6 % to 44 %. Between 44 % and 52 % of people experience symptoms of depression. Prevalence ranges from 1.9 % to 5.2 % for HIV, and 5.7–8.3 % for HBsAg and 0.42–0.66 % for anti-HCV. The population estimates of people who use injectable drugs were 1637 in Bissau, 1314 in Bafatá and 424 in Gabú. CONCLUSION : Methamphetamine and crack cocaine are the most commonly used injectable drugs in Guinea-Bissau. Symptoms of depression are common among people who use drugs in the country. Access to evidence-based drug use treatment and harm reduction interventions that integrate mental health care services are needed to improve the health and wellbeing of people who use drugs in Guinea-Bissau.
Poor health behaviour in medical students at a South African university: a cross-sectional survey study
(MDPI, 2024-07) Celie, Bert; Laubscher, Ria; Bac, Martin; Schwellnus, Marianne; Nolte, Kim; Wood, Paola Silvia; Camacho, Tanya Chantelle de Sousa; Basu, Debashis; Borresen, Jill; paola.wood@up.ac.za
BACKGROUND : Personal health behaviours and lifestyle habits of health professionals influence their counselling practices related to non-communicable diseases (NCDs). There are limited data on the prevalence of unhealthy lifestyle habits among medical students and the impact of acquired health knowledge throughout the curriculum. The aim of this study was to determine and compare the prevalence of modifiable behavioural NCD risk factors of medical students in different academic years at a South African tertiary institution. METHODS : A cross-sectional observational study of 532 consenting medical students was conducted. Participants completed five online questionnaires regarding lifestyle behaviours (physical activity, dietary habits, smoking, alcohol consumption and sleep). RESULTS : Lifestyle-related risk factors with the highest prevalence were poor sleep quality (66.0%), low levels of habitual physical activity (55.8%) and low-to-moderate diet quality (54.5%). There were no differences between academic years for all risk factors measured. Over 60% of the cohort had two or more NCD risk factors and this prevalence did not differ across the degree program with the acquisition of more health knowledge. CONCLUSION : Medical students have a high prevalence of poor sleep quality, low levels of physical activity and low-to-moderate diet quality, which does not appear to change over the course of their academic career. Sleep hygiene, regular physical activity and healthy nutrition should be targeted in intervention programmes and be more prevalent in the medical curriculum.
The war on drugs is a war on us : young people who use drugs and the fight for harm reduction in the Global South
(BMC, 2024-02) Stowe, M.J.; Gatonye, Rita; Maharjan, Ishwor; Kehinde, Seyi; Arya, Sidharth; Valderrábano, Jorge H.; McBride, Angela; Scheibein, Florian; Igonya, Emmy K.; Fast, Danya
In the Global South, young people who use drugs (YPWUD) are exposed to multiple interconnected social and health harms, with many low- and middle-income countries enforcing racist, prohibitionist-based drug policies that generate physical and structural violence. While harm reduction coverage for YPWUD is suboptimal globally, in low and middle-income countries youth-focused harm reduction programs are particularly lacking. Those that do exist are often powerfully shaped by global health funding regimes that restrict progressive approaches and reach. In this commentary we highlight the eforts of young people, activists, allies, and organisations across some Global South settings to enact programs such as those focused on peer-to-peer information sharing and advocacy, overdose monitoring and response, and drug checking. We draw on our experiential knowledge and expertise to identify and discuss key challenges, opportunities, and recommendations for youth harm reduction movements, programs and practices in low- to middle-income countries and beyond, focusing on the need for youth-driven interventions. We conclude this commentary with several calls to action to advance harm reduction for YPWUD within and across Global South settings.
HIV and sexual risk behaviours by 18-25-year old youth at Nyandeni municipality in the Eastern Cape
(AOSIS, 2024-08) Mntonintshi-Mketo, Lorraine N.; Netangaheni, Thinavhuyo Robert; Lefoka, Moganki H.
BACKGROUND: The human immunodeficiency virus (HIV) epidemic in South Africa is among the worst in the world; in 2017, 38% of new infections were among young people aged 15–24 years. Estimates for HIV infection in 2020 worldwide indicate that there will be 1.5 million new cases, 10.2 million untreated cases (out of 37.7 million), and 680 000 deaths from acquired immunodeficiency syndrome (AIDS). Despite a 46% decline in new HIV infections among adolescents and youth over the previous 10 years, two of the seven new HIV infections in 2019 occurred in people between the ages of 15 and 24. HIV prevalence among young people has remained unchanged since 2008. This consistent pattern among people under 30 years of age indicates a failure in HIV prevention. AIM: The study aimed to explore HIV and sexual risk behaviours by 18–25-year-old youth at Nyandeni Municipality in the Eastern Cape province. SETTING: The investigation was conducted Nyandeni Municipality in the Eastern Cape province. METHODS: Qualitative approach was used to explore, describe and investigate the knowledge and attitudes about HIV among the 18–25 years old youth RESULTS: The findings are based on three themes namely, knowledge and attitudes about HIV and AIDS in youth, sexual risk behaviour among youth, and HIV prevention strategies. CONCLUSION: This exploratory investigation confirms that the participants’ knowledge is limited by showing that most of them knew very little about HIV and AIDS infection and prevention. Ongoing educational initiatives are required. CONTRIBUTION: Youth experience high HIV incidence because of their knowledge gaps.
The socio‑demographic profile of family physician graduates of blended‑learning courses in India
(Wolters Kluwer Medknow, 2024-08) Velavan, Jachin; Marcus, Tessa S.
CONTEXT: India’s lean cadre of 250,000 general practitioners and 30,000 government doctors has limited options to update themselves. Since 2006, Christian Medical College (CMC) Vellore has run blended‑learning programs in family medicine, namely, postgraduate diploma in family medicine (PGDFM) and master in medicine in family medicine (M.MED FM) training more than 3000 doctors. A graduate follow‑up study was undertaken in 2022. AIM: The aim of the study was to describe the socio‑demographic characteristics of family physicians (FPs) in India who graduated between 2008 and 2018 from the FM blended‑learning programs run by the CMC, Vellore. SETTINGS AND DESIGN: Informed by an empirical‑analytic paradigm, this descriptive study used a cross‑sectional survey design to uncover graduate FPs’ profiles, practices and experiences. METHODS AND MATERIALS: Using a purposively designed, piloted and validated electronic questionnaire, data were collected between March and July 2022, deidentified and analysed using Statistical Package for Social Sciences (SPSS) TM and Epi InfoTM. RESULTS: Among the 438 FP respondents (36%), there was an almost even split in gender (49.3% male, 50.7% female). Moreover, 25.8% were below the age of 40 years, 37.4% were in the 40–49 age group, and 33.8% were 50 years of age or older; 86% lived and worked in urban areas. The PGDFM or M.MED FM was the highest educational qualification of 64.4% of the doctors. Male FPs pursued postgraduate studies at a significantly younger age and earned significantly more than their female counterparts. CONCLUSIONS: The blended learning model creates an important pathway for doctors, especially women, to pursue higher education with flexibility. Preferential selection criteria can target rural‑based physicians. Strong policy‑level advocacy is needed to establish FM as a specialty with equitable pay scales. Socio‑demographic profiling can be used as an effective advocacy tool.
Reaching for 90:90:90 in correctional facilities in South Africa and Zambia : virtual cross-section of coverage of HIV testing and antiretroviral therapy during universal test and treat implementation
(Lippincott Williams and Wilkins, 2024-08) Hoffmann, Christopher J.; Herce, Michael E.; Chimoyi, Lucy; Smith, Helene J.; Tlali, Mpho; Olivier, Cobus J.; Topp, Stephanie M.; Muyoyeta, Monde; Reid, Stewart E.; Hausler, Harry; Charalambous, Salome; Fielding, Katherine
BACKGROUND : People in correctional settings are a key population for HIV epidemic control. We sought to demonstrate scale-up of universal test and treat in correctional facilities in South Africa and Zambia through a virtual cross-sectional analysis. METHODS : We used routine data on 2 dates: At the start of universal test and treat implementation (time 1, T1) and 1 year later (time 2, T2). We obtained correctional facility census lists for the selected dates and matched HIV testing and treatment data to generate virtual cross-sections of HIV care continuum indicators. RESULTS : In the South African site, there were 4193 and 3868 people in the facility at times T1 and T2; 43% and 36% were matched with HIV testing or treatment data, respectively. At T1 and T2, respectively, 1803 (43%) and 1386 (36%) had known HIV status, 804 (19%) and 845 (21%) were known to be living with HIV, and 60% and 56% of those with known HIV were receiving antiretroviral therapy (ART). In the Zambian site, there were 1467 and 1366 people in the facility at times T1 and T2; 58% and 92% were matched with HIV testing or treatment data, respectively. At T1 and T2, respectively, 857 (59%) and 1263 (92%) had known HIV status, 277 (19%) and 647 (47%) were known to be living with HIV, and 68% and 68% of those with known HIV were receiving ART. CONCLUSIONS : This virtual cross-sectional analysis identified gaps in HIV testing coverage, and ART initiation that was not clearly demonstrated by prior cohort-based studies.
Direct-acting antiviral therapies for hepatitis C infection : global registration, reimbursement, and restrictions
(Elsevier, 2024-04) Marshall, Alison D.; Willing, Alex R.; Kairouz, Abe; Cunningham, Evan B.; Wheeler, Alice; O'Brien, Nicholas; Perera, Vidura; Ward, John W.; Hiebert, Lindsey; Degenhardt, Louisa; Hajarizadeh, Behzad; Colledge, Samantha; Hickman, Matthew; Jawad, Danielle; Lazarus, Jeffrey V.; Matthews, Gail V.; Scheibe, Andrew; Vickerman, Peter; Dore, Gregory J.; Grebely, Jason; Global HCV and HIV Treatment Restrictions Group
Direct-acting antivirals (DAAs) for hepatitis C virus (HCV) infection have delivered high response rates (>95%) and simplified the management of HCV treatment, permitting non-specialists to manage patients without advanced liver disease. We collected and reviewed global data on the registration and reimbursement (government subsidised) of HCV therapies, including restrictions on reimbursement. Primary data collection occurred between Nov 15, 2021, and July 24, 2023, through the assistance of a global network of 166 HCV experts. We retrieved data for 160 (77%) of 209 countries and juristrictions. By mid-2023, 145 (91%) countries had registered at least one of the following DAA therapies: sofosbuvir–velpatasvir, sofosbuvir–velpatasvir–voxilaprevir, glecaprevir–pibrentasvir, sofosbuvir–daclatasvir, or sofosbuvir. 109 (68%) countries reimbursed at least one DAA therapy. Among 102 low-income and middle-income countries (LMICs), 89 (87%) had registered at least one HCV DAA therapy and 53 (52%) reimbursed at least one DAA therapy. Among all countries with DAA therapy reimbursement (n=109), 66 (61%) required specialist prescribing, eight (7%) had retreatment restrictions, seven (6%) had an illicit drug use restriction, five (5%) had an alcohol use restriction, and three (3%) had liver disease restrictions. Global access to DAA reimbursement remains uneven, with LMICs having comparatively low reimbursement compared with high-income countries. To meet WHO goals for HCV elimination, efforts should be made to assist countries, particularly LMICs, to increase access to DAA reimbursement and remove reimbursement restrictions—especially prescriber-type restrictions—to ensure universal access.
Assessing cardiac safety among clients receiving methadone as part of opioid agonist maintenance therapy (OAMT) in Durban, South Africa
(Taylor and Francis, 2023) Prakaschandra, Dorcas Rosaley; Scheibe, Andrew; Marks, Monique; Naidoo, Datshana Prakesh
BACKGROUND : Methadone is a recommended medication for opioid agonist maintenance therapy (OAMT). However, methadone can have cardiac side effects. There is limited South African cardiac safety data on methadone. OBJECTIVE : To describe baseline and 12-month electrocardiographic (ECG) features and cardiac symptomology in people receiving OAMT in Durban, South Africa. METHODS : Twelve-lead ECGs were conducted at baseline and 12 months. Clinical interviews were used to assess cardiac symptomatology. Baseline ECG parameters (PR interval, QRS interval, QT and QTc duration, heart rate) were analyzed using descriptive statistics. Baseline and 12-month ECG characteristics were compared using paired T-tests in retained participants. The association between QTc and methadone dose was assessed using Spearman’s Rho at 12 months. RESULTS : Fifty-three clients (51 men, 2 women [median age 29.0]) were initiated on OAMT. Normal baseline ECG variants included 4 (7.5%) with sinus bradycardia and 3 (5.7%) with ST segment elevation. Mean baseline ECG intervals were PR interval: 156 ± 23 ms, QRS duration: 87 ± 9 ms, QT interval: 404 ± 22 ms and QTc interval: 406.9 ± 21.9 ms. At 12 months, 39 participants returned for reassessment (mean methadone dose: 37 ± 8 mg in women; 27 ± 10 mg in men). QTc intervals among male participants increased (406.4 ± 22 to 417 ± 24; p = 0.026 [−19.6; −1.4]). No significant correlation (r = 0.22; p = 0.185) between methadone dose and QTc interval at 12 months, nor reports of adverse cardiac symptomatology, were detected. CONCLUSION : Methadone at the doses provided, caused mild and clinically insignificant QTc interval prolongation in men at 12 months. We provide additional cardiac safety data for the use of methadone for OAMT among people with opioid use disorder.

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