Research Publications (Health Sciences)

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Cervical cancer screening among University students in South Africa : a theory based study
(PLOS, 2014-11) Hoque, Muhammad Ehsanu; Ghuman, Shanaz; Coopoosmay, Roger; Hal, Guido Van
Introduction: Cervical cancer is a serious public health problem in South Africa. Even though the screening is free in health facilities in South Africa, the Pap smear uptake is very low. The objective of the study is to investigate the knowledge and beliefs of female university students in South Africa. Methods: A cross sectional study was conducted among university women in South Africa to elicit information about knowledge and beliefs, and screening history. Results: A total of 440 students completed the questionnaire. The average age of the participants was 20.39 years (SD = 1.71 years). Regarding cervical cancer, 55.2% (n = 243) had ever heard about it. Results indicated that only 15% (22/147) of the students who had ever had sex and had heard about cervical cancer had taken a Pap test. Pearson correlation analysis showed that cervical cancer knowledge had a significantly negative relationship with barriers to cervical cancer screening. Susceptibility and seriousness score were significantly moderately correlated with benefit and motivation score as well as barrier score. Self-efficacy score also had a moderate correlation with benefit and motivation score. Students who had had a Pap test showed a significantly lower score in barriers to being screened compared to students who had not had a Pap test. Conclusion: This study showed that educated women in South Africa lack complete information on cervical cancer. Students who had had a Pap test had significantly lower barriers to cervical cancer screening than those students who had not had a Pap test.
Community perceptions of the socio-economic structural context influencing HIV and TB risk, prevention and treatment in a high prevalence area in the era of antiretroviral therapy
(National Inquiry Services Center (NISC), 2018-03) Ngwenya, Nothando; Gumede, Dumile; Shahmanesh, Maryam; McGrath, Nuala; Grant, Alison; Seeley, Janet
Following calls for targeted HIV prevention interventions in so-called "hotspots", we explored subjective perceptions of community members in places considered to be high HIV and tuberculosis (TB) transmission areas and those with low prevalence. Although more people now have access to antiretroviral therapy (ART), some areas are still experiencing high HIV transmission rates, presenting a barrier to the elimination of HIV. A rapid qualitative assessment approach was used to access a sample of 230 people who contributed narratives of their experiences and perceptions of transmission, treatment and prevention of HIV and TB in their communities. Theoretical propositions case study strategy was used to inform and guide the thematic analysis of the data with Research Department of Epidemiology & Public Health, University College London, London, UK. Our results support the concept of linking perceived control to health through the identification of structural factors that increase communities' sense of agency. People in these communities did not feel they had the efficacy to effect change in their milieu. The few socio-economic opportunities promote social mobility in search of better prospects which may have a negative impact on community cohesion and prevention strategies. Communities were more concerned with improving their immediate social and economic situations and prioritised this above the prevention messages. Therefore approaches that focus on changing the structural and environmental barriers to prevention may increase people's perceived control. Multifaceted strategies that address the identified constructs of perceived control may influence the social change necessary to make structural interventions successful.
Complementary therapy in atopic eczema: the latest systematic reviews
(Taylor and Francis, 2014) Thandar, Yasmeen; Botha, Julia; Mosam, Anisa
Complementary and alternative medicines (CAM) are widely used for atopic eczema (AE) with user estimates as high as 63%. Despite the availability of effective conventional therapies, the chronic nature of AE and concerns about long-term steroid use lead many patients to seek alternative treatment. Evidence of the efficacy of these alternative therapies is inconsistent and available published data have shortcomings, making it difficult for clinicians to assess their role, if any, in management. To assess the evidence, systematic reviews of controlled studies have been undertaken for Chinese herbal medicines, homeopathy, evening primrose oil, borage oil, probiotics and certain dietary supplements. This overview summarises the findings from the most recent systematic reviews. Taken together, none of the alternative therapies evaluated demonstrated obvious and indisputable evidence of efficacy. Further studies are warranted with some therapies (Chinese herbal medicines, certain probiotic strains and fish oil), whereas homeopathy failed to show any treatment effect. Further studies on homeopathy, or evening primrose oil and borage oil, are difficult to justify. It must also be remembered that CAM products are currently under-regulated and may not meet the stringent quality standards of conventional medicines.
Effect of the TNF α-308 polymorphism on birth outcomes among South African women
(JABS, 2014-04) Reddy, Poovendhree; Naidoo, Rajen N.; Chuturgoon, Anil A.; Asharam, Kareshma; Phulukdaree, Alisa; Gounden, Shivona
The −308 G/A promoter polymorphism in the tumor necrosis factor-alpha (TNF- α) gene has been extensively studied as a potential biomarker for pregnancy outcomes, but results tend to be population specific. The aim of this study was to evaluate the association of the TNF α-308 polymorphism with preterm birth (PTB) and low birth weight (LBW) in a cohort of South African women enrolled in a prospective pregnancy study. The Mother and Child Environmental cohort (MACE) pilot study was done in Durban, KwaZulu-Natal during 2010-2011 with 100 pregnant women recruited. Demographic, exposure and prenatal clinical data was collected during the third trimester, maternal and infant hospital records at delivery were reviewed. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to determine the TNF-α -308 genotype. Plasma TNF-α concentration was measured using the human TNF-α Max Standard™ ELISA kit (Bio-legend). The polymorphic TNF-α GA+AA genotype was found among 35% of mothers. Mean birth weight was significantly lower among mothers with the TNF-α AG+AA genotype (p<0.05). Mothers who delivered LBW infants (<2500g) showed a significantly higher mean TNF- α level compared to mothers with normal birth weight deliveries. In addition, mothers with the TNF-α AG+AA genotype had a statistically significant drop in birth weight (β= -273.6; SE105.8; CI: -0.9,-1.35). While the TNF-α A allele was not associated with PTB, it was significantly associated with low birth weight in this study. Early identification of such immunological biomarkers may facilitate prevention of adverse pregnancy outcomes.
Effects of a Teenage Pregnancy Prevention Program in KwaZulu-Natal, South Africa
(Routledge, 2014-06-19) Taylor, Myra; Dlamini, Siyabonga; Eggers, Matthijs S.; De Vries, Hein; Jinabhai, Champaklal C.
Researchers aimed to determine the effects of a teenage pregnancy (TP) prevention program for 816 high school students attending 16 KwaZulu-Natal, South African schools through a randomized control trial. Data were collected at baseline and at the 8-month follow-up in 2009. Results were calculated using multivariate anal-yses of program effects employing Mplus 6, and indicated signiﬁ-cantly healthier attitudes, including intentions to abstain from sex whilst at school, plans to communicate with partners about teenage pregnancy, and increased reports of condom use. Researchers thus provide some support for the effectiveness of a TP prevention pro-gram that should be further strengthened in a comprehensive ap-proach that includes schools and families.
Enhancing education through community engagement : perspectives of student volunteers
(2023) Kell, C. M.; Haffejee, Firoza; Ducray, J. F.
Background. Engagement between higher education institutions and underprivileged communities holds valuable potential for mutual benefit. In a country of vast inequalities such as South Africa (SA), community engagement also has the potential, via health promotion of local communities, to alleviate some of the burden placed on the public healthcare system, while simultaneously strengthening the personal and professional development of student participants. Objective. To explore the experiences, perceptions and insights of student volunteers (SVs) who assisted with a collaborative health-promotion project. Methods. This qualitative study used thematic analysis of semi-structured interviews to explore the experiences of six SVs in the Faculty of Health Sciences, Durban University of Technology, SA, who assisted in educating local vulnerable women on various aspects of female reproductive health at a wellness day for such women. Results. The SVs described the experience as positive and humbling, enhancing their professional and personal development. They reported that the community engagement helped them to define themselves and to grow skills they will need as future practitioners. The exposure to the challenges faced by vulnerable groups helped them to develop a sense of empathy and compassion, while igniting an eagerness to empower these groups through improved health literacy. Conclusion. The insights provided by this qualitative exploration strongly support the use of community engagement to develop culturally sensitive, empathetic healthcare practitioners.
Evidence of application of the Basic Antenatal Care principles of good care and guidelines in pregnant women’s antenatal care records
(AOSIS Publishing, 2016-05-31) Ngxongo, Thembelihle Sylvia Patience; Sibiya, Maureen Nokuthula; Gwele, Nomthandazo S.
Background: Basic Antenatal Care (BANC) is an approach that is used in the public health institutions of South Africa to provide health care services to pregnant women. The approach was introduced as a quality improvement strategy based on the belief that good quality Antenatal Care (ANC) could reduce maternal and perinatal mortalities and improve maternal health. Aim: The aim of this study was to analyse pregnant women’s ANC records for evidence suggesting that the BANC principles of good care and guidelines were being applied. Setting: The study was conducted in the 12 primary health care clinics that were providing ANC services using the BANC approach in eThekwini district, KwaZulu-Natal. Methods: A cross-sectional quantitative design was used to conduct the study. Data were collected through retrospective record review of 1200 maternity case records of the pregnant women who had attended for ANC services three or more times and was analysed using Statistical Package for Social Sciences (SPSS) version 21.0. Results: The majority of the processes detailed in the guidelines and principles of good care were evident in the records. However, several were missing or recorded in few reviews. These included the ANC plan, delivery plan, midwives’ counter signatures on the cards, assessment for foetal congenital abnormalities, and consent for HIV testing. Conclusion: The study identified evidence of incomplete application of the BANC principles of good care and guidelines in pregnant women’s antenatal care records which indicated that the BANC approach was not being successfully implemented. Recommendations were made with regards to policy development, institutional management and practise, nursing education, and further research to assist in successful implementation of the BANC approach in line with the guidelines and principles of good care.
Exploring adolescents and young people's candidacy for utilising health services in a rural district, South Africa
(Springer Science and Business Media LLC, 2019-03-28) Nkosi, Busisiwe; Seeley, Janet; Ngwenya, Nothando; Mchunu, S. Lerato; Gumede, Dumile; Ferguson, Jane; Doyle, Aoife M.
We use the 'candidacy framework' to describe adolescents' and young people's (AYP) experiences of health services in a rural KwaZulu-Natal district, South Africa.
Methods
A qualitative approach was used including group discussions, in-depth and key informant interviews with a purposive sample of AYP (n = 70), community leaders (n = 15), school health teams (n = 10), and health service providers (n = 6).
Results
Findings indicate tacit understanding among AYP that they are candidates for general health services. However, HIV stigma, apprehensions and misconceptions about sexual and reproductive health, and socio-cultural views which disapprove of AYP pre-marital sex undermine their candidacy for sexual and reproductive services.
Conclusion
Consideration and understanding of the vulnerabilities and reasons AYP exclude themselves will inform interventions to address their health needs. AYP's participation in the design of health services will increase their acceptability and encourage uptake of services.
Exploring intersectionality and HIV stigma in persons receiving HIV care in nurse-led public clinics in Durban, South Africa
(Elsevier BV, 2023) Sokhela, Dudu Gloria; Orton, Penelope Margaret; Nokes, Kathleen M.; Samuels, William E.
Background: Although stigma associated with South African people living with HIV has declined since the 1980s when HIV/AIDS was first identified, it still persists. Stigma is associated with poor health outcomes and avoidance of interactions with healthcare systems. The HIV stigma framework distinguishes three HIV-related self-stigma mechanisms. Aims: The aims of this study were to explore intersectionality between HIV-stigma mechanisms and selected sociodemographic as well as HIV factors, and interrelationships between three HIV-related self-stigma mechanisms. Setting and method: This study was a secondary analysis of data collected from a cross-sectional sample of people receiving HIV-related primary health care at different municipal clinics in Durban, South Africa (N = 100). Results: The average participant was Black African, female, unemployed, with a monthly income below R2 500, most had completed primary school. No sociodemographic or HIV-related factors were significantly related to total or subscale HIV stigma scores. Respondents reported experiencing (enacted) no stigmatization, did not expect to experience (anticipated) much stigmatization from their social interactions with family, community, healthcareworkers, and reported no strong stigmatizing beliefs about themselves (internalized). Conclusion: Intersectionality did not identify any particular socio-demographic or HIV-related factor associated with greater HIV stigma. Participants reported low HIV stigma arising from interactions with healthcare and social service providers or families. Although no socio-demographic or HIV-related factors were significantly associated with HIV stigma mechanisms in this relatively homogeneous sample, being marginalized can nevertheless result from living with other differences compared to societal norms and result in particular vulnerability when living with HIV/AIDS.
Exploring the interrelationships between physical function, functional exercise capacity, and exercise self-efficacy in persons living with HIV
(SAGE Publications, 2024) Nokes, Kathleen M.; Sokhela, Dudu G.; Orton, Penelope Margaret; Samuels, William Ellery; Phillips, J. Craig; Tufts, Kimberly Adams; Perazzo, Joseph D.; Chaiphibalsarisdi, Puangtip; Portillo, Carmen; Schnall, Rebecca; Hamilton, Mary Jane; Dawson-Rose, Carol; Webel, Allison R.
While physical activity can mitigate the metabolic effects of HIV disease and HIV medications, many HIV-infected persons report low levels of physical activity. Purpose: To determine if there were differences between the subjective and objective assessments of physical activity while controlling for sociodemographic, anthropometric, and clinical characteristics. Setting/sample: A total of 810 participants across eight sites located in three countries. Measures: Subjective instruments were the two subscales of Self-efficacy for Exercise Behaviors Scale: Making Time for Exercise and Resisting Relapse and Patient-Reported Outcomes Measurement Information System, which measured physical function. The objective measure of functional exercise capacity was the 6-minute Walk Test. Analysis: Both univariate and multivariant analyses were used. Results: Physical function was significantly associated with Making Time for Exercise (β = 1.76, p = .039) but not with Resisting Relapse (β = 1.16, p = .168). Age (β = −1.88, p = .001), being employed (β = 16.19, p < .001) and race (βs = 13.84–31.98, p < .001), hip–waist ratio (β = −2.18, p < .001), and comorbidities (β = 7.31, p < .001) were significant predictors of physical functioning. The model predicting physical function accounted for a large amount of variance (adjusted R2 = .938). The patterns of results predicting functional exercise capacity were similar. Making Time for Exercise self-efficacy scores significantly predicted functional exercise capacity (β = 0.14, p = .029), and Resisting Relapse scores again did not (β = −0.10, p = .120). Among the covariates, age (β = −0.16, p < .001), gender (β = −0.43, p < .001), education (β = 0.08, p = .026), and hip–waist ratio (β = 0.09, p = .034) were significant. This model did not account for much of the overall variance in the data (adjusted R2 = .081). We found a modest significant relationship between physical function and functional exercise capacity ( r = 0.27). Conclusions: Making Time for Exercise Self-efficacy was more significant than Resisting Relapse for both physical function and functional exercise capacity. Interventions to promote achievement of physical activity need to use multiple measurement strategies.
If you are here at the clinic, you do not know how many people need help in the community : perspectives of home-based HIV services from health care workers in rural KwaZulu-Natal, South Africa in the era of universal test-and-treat
(Public Library of Science (PLoS), 2018-01) Perriat, Delphine; Plazy, Mélanie; Gumede, Dumile; Boyer, Sylvie; Pillay, Deenan; Dabis, François; Seeley, Janet; Orne-Gliemann, Joanna; ANRS 12249 TasP Study Group
Limited engagement in clinic-based care is affecting the HIV response. We explored the field experiences and perceptions of local health care workers regarding home-based strategies as opportunities to improve the cascade of care of people living with HIV in rural South Africa as part of a Universal Test-and-Treat approach.
Methods
In Hlabisa sub-district, home-based HIV services, including rapid HIV testing and counselling, and support for linkage to and retention in clinic-based HIV care, were implemented by health care workers within the ANRS 12249 Treatment-as-Prevention (TasP) trial. From April to July 2016, we conducted a mixed-methods study among health care workers from the TasP trial and from local government clinics, using self-administrated questionnaires (n = 90 in the TasP trial, n = 56 in government clinics), semi-structured interviews (n = 13 in the TasP trial, n = 5 in government clinics) and three focus group discussions (n = 6-10 health care workers of the TasP trial per group). Descriptive statistics were used for quantitative data and qualitative data were analysed thematically.
Results
More than 90% of health care workers assessed home-based testing and support for linkage to care as feasible and acceptable by the population they serve. Many health care workers underlined how home visits could facilitate reaching people who had slipped through the cracks of the clinic-based health care system and encourage them to successfully access care. Health care workers however expressed concerns about the ability of home-based services to answer the HIV care needs of all community members, including people working outside their home during the day or those who fear HIV-related stigmatization. Overall, health care workers encouraged policy-makers to more formally integrate home-based services in the local health system. They promoted reshaping the disease-specific and care-oriented services towards more comprehensive goals.
Conclusion
Because home-based services allow identification of people early during their infection and encourage them to take actions leading to viral suppression, HCWs assessed them as valuable components within the panel of UTT interventions, aiming to reach the 90-90-90 UNAIDS targets, especially in the rural Southern African region.
Trial registration
The registration number of the ANRS 12249 TasP trial on ClinicalTrials.gov is NCT01509508.
Integrating cervical cancer prevention initiatives with HIV care in resource-constrained settings: A formative study in Durban, South Africa
(Taylor and Francis, 2015) Ports, Katie A.; Haffejee, Firoza; Mosavel, Maghboeba; Rameshbabu, Anjali
Cervical cancer screening rates remain suboptimal among women in South Africa (SA), where cervical cancer prevalence is high. The rollout of HIV-related services across SA may provide a means to deliver cervical cancer screening to populations with limited access to health care systems. In this mixed methods study, psychosocial factors influencing cervical cancer prevention and perceptions of the provision of Pap smears in HIV care settings were examined. Structured interviews were conducted with women (n = 67) from a municipal housing estate in Durban, SA. Key informants (n = 12) also participated in semi-structured interviews. Findings revealed that participants had low cervical cancer knowledge, but desired more information. Relevant themes included the normalisation of HIV and beliefs that cervical cancer might be worse than HIV. A comprehensive community clinic was desired by most, even if HIV-positive patients were treated there. This study provides important insight into integrating cervical cancer screening with HIV clinics, which may increase cancer screening among South African women.
Knowledge and attitudes about HIV infection and prevention of mother to child transmission of HIV in an urban, low income community in Durban, South Africa: Perspectives of residents and health care volunteers
(AOSIS Publishing, 2016) Haffejee, Firoza; Ports, Katie A.; Mosavel, Maghboeba
Background: HIV prevalence is high among South African women of reproductive age and transmission of HIV from mothers to children is a concern. This study ascertained the level of knowledge about HIV infection and prevention, particularly prevention of mother to child transmission (PMTCT) amongst South African women from a low income commu-nity. It also established the challenges in delivering HIV education from the perspectives of health care volunteers. Method: Female residents (n ¼ 67) from Kenneth Gardens, a low income community in Durban, South Africa were interviewed. In-depth semi-structured interviews were con-ducted with 12 health care volunteers who were either health care workers or residents who provided some form of social support in the community. Results: Themajority of respondents indicated that amother could transmit HIV to her child but were unable to specify how. Many women had general HIV/AIDS knowledge but were unable to identify essential prevention behaviours and were not very receptive to more information on HIV/AIDS. They were supportive of routine testing procedures and child bearing amongst HIV positive women. Health care volunteers indicated a need for a community clinic in the area. They also had limited knowledge of PMTCT and indicated that there was a need for more ed-ucation on HIV, particularly to encourage the youth and men to use preventative measures. Conclusion: Innovative ways to impart knowledge particularly of PMTCT and updated standards of practice are essential. It is important that the community understands how transmission occurs so that prevention can follow.
Minibus taxi drivers’ sexual beliefs and practices associated with HIV infection and AIDS in KwaZulu-Natal, South Africa
(AOSIS, 2013-01-08) Ncama, Busisiwe; Mchunu, Gugu; Naidoo, Joanne; Majeke, Sisana; Pillay, Padmini; Myeza, Thandazile; Ndebele, Thandiwe
Risky sexual behaviours in South Africa are a major contributing factor to the spread of HIV infection and AIDS. HIV infection amongst minibus taxi drivers is a concern, because these people belong to an occupational group that exhibits risky behaviours due to the demands of their work. Given the high vulnerability of minibus taxi drivers, exploring the sexual beliefs and health-related sexual practices of this group will assist in planning targeted interventions. The objectives of this study were to assess the level of knowledge, beliefs and practices regarding HIV infection and AIDS amongst minibus taxi drivers. An exploratory descriptive study was conducted using a pre-tested questionnaire to explore and describe sexual beliefs and practices associated with HIV infection and AIDS in a convenience sample of 175 minibus taxi drivers. Permission to undertake the study was obtained from the KwaZulu-Natal Taxi Alliance and individuals who participated in the study. Data analysis were analysed using the Statistical Package for Social Sciences 13.0. The study revealed that minibus taxi drivers are one of the high- risk groups in the spread of HIV infection and AIDS; they lack necessary education and need attention in relation to control and prevention of the spread of HIV and AIDS. Multiple sexual partners are relatively common amongst the minibus taxi drivers. Violence against women and even forceful sexual intercourse in the belief that women should tolerate it to keep the family together was reported. There is a need for intervention programmes with a focus on minibus taxi drivers and similar high-risk groups. Prevention activities should incorporate the distribution of condoms amongst this group and HIV prevention educational programmes, as well as creating mechanisms for accessing circumcision by the minibus taxi drivers.
Perceptions of facilitators using case-based educational strategies in a nursing management decentralized program in South Africa
(Post Academic Publications, 2013-06) Nkosi, Zethu; Pillay, Padmini; Nokes, Kathleen M.
Background: Case-based education has a long history in the disciplines of education, business, law and the health professions. Research suggests that students who learn via a case-based method have advanced critical thinking skills and a greater ability for application of knowledge in practice. In medical education, case-based methodology is widely used to facilitate knowledge transfer from theoretical knowledge to application in patient care. Nursing education has also adopted case-based methodology to enhance learner outcomes and critical thinking. Objectives: The objective of this study was to explore the perceptions of case-based facilitators in a decentralised nursing management education program located in Durban, South Africa. Methods: This descriptive, exploratory study used focus groups to examine perceptions of facilitators (N=15) using case-based education in a nursing management program. Results: The average facilitator was female, between 41 and 50 years of age, working part-time, educated with a baccalaureate degree, working as a professional nurse between 11 and 20 years, and slightly more than half had worked as a facilitator 3 or more years. The three major themes emerged were related to the student learners, the learning environment, and using facilitation to teach the programme. Conclusion: Decentralised nursing management educational programs can meet the needs of nurses who are located in remote areas which are characterised by poor transportation patterns and limited resources and have great need for quality healthcare services.
Prenatal exposures and DNA methylation in newborns: A pilot study in Durban, South Africa
(Royal Society of Chemistry, 2016) Goodrich, Jaclyn M.; Reddy, Poovendhree; Naidoo, Rajen N.; Asharam, Kareshma; Batterman, Stuart; Dolinoy, Dana C.
The in utero environment has the potential to influence epigenetic programming and subsequently the health of offspring. Even though pregnant women living in urban Africa are exposed to multiple chemicals and infectious agents that may impact their developing children, the neonatal epigenome has not been studied in these regions. We assessed whether prenatal exposures to air pollution and maternal human immunodeficiency virus (HIV) are associated with changes to DNA methylation throughout the epigenome using a pilot sample from the Mother and Child Environmental (MACE) birth cohort, of which 36% of the mothers are HIV positive. Families living in a high air pollution region (south Durban, n = 11) and a low air pollution region (north Durban, n = 11) with comparable socioeconomic characteristics were selected for analysis. DNA methylation was quantified in cord blood plasma DNA at >430 000 CpG sites using the Infinium HumanMethylation450 BeadChip. Sites associated with living in south Durban or maternal HIV infection (p < 0.001) were more likely to be hypomethylated and located in CpG islands. Top differentially methylated sites by region of Durban were enriched in pathways related to xenobiotic metabolism, oxygen and gas transport, and sensory perception of chemical stimuli when performing gene set enrichment testing with LRpath. Differentially methylated sites by maternal HIV status were enriched in cytochrome P450s, pathways involved in detection of chemical stimuli, metabolic processes, and viral regulation and processing. Given the small sample size of the study, future work examining the impact of prenatal exposures to air pollution, maternal infection, and antiviral treatment on the epigenome and downstream health implications is merited in Sub-Saharan African populations.
Qualitative evaluation of selected social factors that impact sexual risk-taking behaviour among African students in Kwazulu-Natal, South Africa
(Taylor and Francis, 2016) Ngidi, Ndumiso Daluxolo; Moyo, Sibusiso; Zulu, Thobile; Adam, Jamila Khatoon; Krishna, Suresh Babu Naidu
The incidence of HIV and AIDS continues to be a source of great concern within universities in South Africa. Furthermore, university students constitute an important community in the intervention against the HIV/AIDS epidemic. Students in the age group of 15–24 years are at a greater risk of HIV infection than any other group in the country; yet, little is known about why they continue to engage in risky sexual practices. Objectives: This study was designed to explore the sexual behaviour of students in a metropolitan Durban University of Technology in KwaZulu-Natal to understand the social factors underlying their risk of HIV infection. Methods: This is a qualitative study that used cluster sampling where the population was stratiﬁed by campus and faculty. The study population was selected using a standard randomization technique. This was a part of a multi-phased research project aimed at providing a sero-prevalence baseline and an analysis of risk-taking behaviour at a Durban University of Technology in the eThekwini Metropolitan Municipality area. Results: The study highlights peer pressure among students as an inﬂuence in promoting high-risk sexual behaviour. Within this context, the ﬁndings revealed that university students lack the ability to negotiate risk-aware decisions especially regarding sexual relationships. Conclusion: This study draws attention to the perspectives of African university students regarding their risk-taking sexual practices and selected factors which inﬂuence such behaviour. The ﬁndings are not exhaustive in exploring contextual antecedents that shape students’ sexual practices. However, they provide an important basis in understanding key factors which expose students to HIV infections. The study provides insights into opportunities for further studies as well as preventative implications.
A qualitative investigation of facilitators and barriers to DREAMS uptake among adolescents with grandparent caregivers in rural KwaZulu-Natal, South Africa
(Public Library of Science (PLoS), 2022) Gumede, Dumile; Meyer-Weitz, Anna; Zuma, Thembelihle; Shahmanesh, Maryam; Seeley, Janet
Adolescents with grandparent caregivers have experienced challenges including the death of one or both parents due to HIV in sub-Saharan Africa. They may be left out of existing HIV prevention interventions targeting parents and children. We investigated the facilitators and barriers to DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored and Safe) programme uptake among adolescents with grandparent caregivers across different levels of the socio-ecological model in rural South Africa. Data were collected in three phases (October 2017 to September 2018). Adolescents (13–19 years old) and their grandparent caregivers (≥50 years old) (n = 12) contributed to repeat in-depth interviews to share their perceptions and experiences regarding adolescents’ participation in DREAMS. Data were triangulated using key informant interviews with DREAMS intervention facilitators (n = 2) to give insights into their experiences of delivering DREAMS interventions. Written informed consent or child assent was obtained from all individuals before participation. All data were collected in isiZulu and audio-recorded, transcribed verbatim and translated into English. Thematic and dyadic analysis approaches were conducted guided by the socio-ecological model. Participation in DREAMS was most effective when DREAMS messaging reinforced existing norms around sex and sexuality and when the interventions improved care relationships between the adolescents and their older caregivers. DREAMS was less acceptable when it deviated from the norms, raised SRH information that conflicts with abstinence and virginity, and when youth empowerment was perceived as a potential threat to intergenerational power dynamics. While DREAMS was able to engage these complex families, there were failures, about factors uniquely critical to these families, such as in engaging children and carers with disabilities and failure to include adolescent boys in some interventions. There is a need to adapt HIV prevention interventions to tackle care relationships specific to adolescent-grandparent caregiver communication.
Reducing the alloy thickness of base metal ceramic restorations
(Dental Technicians Association of South Africa, 2009) Le Roux, Andre Rayne
Reduction in base metal alloy thickness will permit additional porcelain depth and improved aesthetics but unfortunately little information exists regarding the thickness to which base metal alloys may be reduced in comparison to noble metal alloys for metal ceramic restorations. Even with comparison of noble metal alloys the aesthetic benefits are restricted to improving aesthetics in base metal restoration further, since noble metal alloys are generally regarded as providing superior aesthetics to base metal restorative alloys. Purpose: The objective of this study was to determine whether a significant reduction in thickness could be achieved using a base metal alloy as compared to a noble metal alloy and the thickness to which base metal alloy substructures could safely be reduced while still providing the same resistance to fracture of the porcelain. Material and methods: Tensile strength tests (N) of the modulus of rupture of the porcelain were performed on 40 base metal alloy (Wiron 99, Bego, Germany) and 12 noble metal alloy rectangular specimens (5.8 mm wide and 15.0 mm long) bonded to a standardized 1.0 mm thickness of dentine Creation porcelain. The base metal alloy thickness varied in 0.1mm increments from 0.1 to 0.4 mm. The results were compared to 12 noble metal alloy (Bio Y 81, Argen, South Africa) specimens of recommended minimum thickness (0.3 mm). Data for the results was obtained using a universal tensile testing instrument, which was set to operate at a cross head speed of 0.5mm (Instron Mini 44, Instron corporation U.S.A). The applied force (N) that measured the modulus of rupture of each specimen was printed from a computer connected to the Instron Mini 44 that operated on a 95% level of confidence. Instron Agents (Durban, South Africa) performed the calibration and setting up of the machine prior to testing the specimens. Results: The results indicated a permissible 33.33% reduction in the base metal alloy specimens as compared to the noble metal alloy control specimens. This was deduced from the reduction in alloy thickness of up to 0.2 mm for base metal alloy specimens as compared to the 0.3 mm noble metal alloy specimens. The recommended thickness to which the base metal alloys could be reduced without distortion of the alloy was also 0.2 mm. The one-way ANOVA showed a level of significance of (α=05).
The role of trophoblast cell receptor expression in HIV-1 passage across the placenta in pre-eclampsia: an observational study
(Wiley, 2016-10-03) Dorsamy, V.; Vallen, C.; Haffejee, Firoza; Moodley, J.; Naicker, T.
Objective To compare expression of markers of HIV and associated receptors (p24, CD4, CCR5 and ICAM-2) in placentae and umbilical cords of HIV-associated and pre-eclamptic pregnancies to elucidate any association between these conditions in mother-to-child transmission. Design Cross-sectional immunohistochemical analysis of target receptor expression. Setting Laboratory-based study of primigravidae attending a district hospital in South Africa. Population or sample Retrospectively collected placental tissue (stratiﬁed into four groups according to HIV status of normotensive and pre-eclamptic participants (n = 20/group). Method Immunohistochemistry utilising CD4 (1:1), p24 (1:10), CCR5 (1:80) and ICAM-2 (1:100) antibodies was performed using light microscopy for image acquisition and analysis. Main outcome measures Evaluate the expression of receptors on syncytiotrophoblast involved in in utero transmission of HIV. Results Syncytiotrophoblast was immunopositive for CD4 and CCR5 antibody with greater expression of CCR5 in HIV-positive versus HIV-negative groups (F1,159 = 6.979, P = 0.009) and normotensive versus pre-eclamptic groups (F1,159 = 8.803, P = 0.003). p24 was present in both placentae and umbilical cords of babies that were HIV-negative at 6 weeks. ICAM-2 immunostaining was observed in the syncytiotrophoblast across study groups and was signiﬁcantly higher in the HIV-negative pre-eclamptic group (v2 (3) = 45.3; P < 0.001). Conclusion Concurrent CD4 and CCR5 receptor expression demonstrates possible in utero viral entry routes across the placental barrier. ICAM-2 expression may inﬂuence HIV passage across the placenta or restoration of risk of pre-eclampsia in HAART-treated mothers. HIV was found in fetal circulation regardless of antiretroviral treatment. Further conﬁrmatory ultrastructural and molecular work is warranted.

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Results

Conclusion

Trial registration