Research Publications (Health Sciences)
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Item Determinants and acceptability of HIV self-testing among vulnerable groups in sub-Saharan Africa : a scoping review protocol(BMJ, 2024-01-29) Anyiam, Felix Emeka; Sibiya, Maureen Nokuthula; Oladimeji, OlanrewajuHIV self-testing (HIVST) is where individuals collect their specimens and perform the HIV test privately. HIVST has improved testing uptake and coverage, especially among vulnerable groups of sub-Saharan Africa (SSA). Vulnerable groups include key populations such as men who have sex with men, sex workers, people who inject drugs, lesbian, gay, bisexual and transgender persons and young women. However, little is known about the determinants and acceptability of HIVST among these groups in SSA. Therefore, this scoping review aims to explore the determinants and acceptability of HIVST among vulnerable groups in SSA.Methods
A scoping review will be conducted using the Arksey and O'Malley framework and further refined by Levac framework. The review will follow a six-step approach: (1) identifying the research question, (2) identifying relevant studies, (3) study selection eligibility, (4) charting the data, (5) collating, summarising and reporting the results and (6) consultation. A comprehensive search strategy will be developed, and the following electronic databases will be searched: MEDLINE, Embase, Global Health and the Cochrane Library. Grey literature will also be searched, including conference abstracts and reports. Eligibility criteria will include studies conducted in SSA, published between 2010 and 2023, focusing on vulnerable groups and exploring the determinants and acceptability of HIVST. Two independent reviewers will screen identified studies' titles, abstracts and full texts. Any disagreements will be resolved through discussion or consultation with a third reviewer. Data extraction will be conducted using a standardised form.Ethics and dissemination
This review, not requiring ethical approval, aims to inform policy and intervention design to boost HIV testing adoption within vulnerable communities. We plan to disseminate our findings via a peer-reviewed journal, policy briefs, conference presentations and stakeholder engagement.Item 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.Item Factors related to functional exercise capacity amongst people with HIV in Durban, South Africa(AOSIS, 2021-04-29) Orton, Penelope Margaret; Sokhela, Dudu Gloria; Nokes, Kathleen M.; Perazzo, Joseph D.; Webel, Allison R.BackgroundPeople with HIV (PWH), who engage in regular physical activity, have improved fitness, muscular strength, body composition, health-related quality of life and mental health symptoms, but PWH have amongst the lowest physical activity levels of those with any chronic health condition. Furthermore, there is scant evidence examining these relationships in PWH in Africa.Aim
To address these critical gaps, this cross-sectional descriptive research study examined the relationships between demographic, HIV-related, anthropometric factors, neighbourhood walkability and physical activity, amongst PWH in Durban, South Africa.Setting
Respondents (N = 100) were receiving primary healthcare in six eThekwini nurse-run municipal clinics.Methods
Self-reported socio-demographic data were collected, and HIV-related medical data were extracted from respondent's medical charts. Height and weight were measured to calculate the body mass index (BMI, kg/m2); neighbourhood walkability was measured on the Neighbourhood Environment scale; and physical activity, specifically functional exercise capacity, was measured by the 6-min walk test (6MWT).Results
On average, respondents were black African, female, approximately 38 years old and unemployed; men were of normal weight whilst women were overweight. Only 65% of the respondents reached the age- and sex-predicted distance during the 6MWT. Correlational analyses did not reveal any significant relationships between the functional exercise capacity and socio-demographic, HIV-related factors or anthropometric measures.Conclusion
South African PWH do not reach their predicated walking distance on the 6MWT. Engaging community agencies to promote walking as both a means of transportation and leisure physical activity may decrease the risks of a sedentary lifestyle and improve progression towards recommended physical activity targets.Item Implementing universal HIV treatment in a high HIV prevalence and rural South African setting : field experiences and recommendations of health care providers(Public Library of Science (PLoS), 2017-01) Plazy, Melanie; Perriat, Delphine; Gumede, Dumile; Boyer, Sylvie; Pillay, Deenan; Dabis, François; Seeley, Janet; Orne-Gliemann, JoannaWe aimed to describe the field experiences and recommendations of clinic-based health care providers (HCP) regarding the implementation of universal antiretroviral therapy (ART) in rural KwaZulu-Natal, South Africa.Methods
In Hlabisa sub-district, the local HIV programme of the Department of Health (DoH) is decentralized in 18 clinics, where ART was offered at a CD4 count ≤500 cells/μL from January 2015 to September 2016. Within the ANRS 12249 TasP trial, implemented in part of the sub-district, universal ART (no eligibility criteria) was offered in 11 mobile clinics between March 2012 and June 2016. A cross-sectional qualitative survey was conducted in April-July 2016 among clinic-based nurses and counsellors providing HIV care in the DoH and TasP trial clinics. In total, 13 individual interviews and two focus groups discussions (including 6 and 7 participants) were conducted, audio-recorded, transcribed, and thematically analyzed.Results
All HCPs reported an overall good experience of delivering ART early in the course of HIV infection, with most patients willing to initiate ART before being symptomatic. Yet, HCPs underlined that not feeling sick could challenge early ART initiation and adherence, and thus highlighted the need to take time for counselling as an important component to achieve universal ART. HCPs also foresaw logistical challenges of universal ART, and were especially concerned about increasing workload and ART shortage. HCPs finally recommended the need to strengthen the existing model of care to facilitate access to ART, e.g., community-based and integrated HIV services.Conclusions
The provision of universal ART is feasible and acceptable according to HCPs in this rural South-African area. However their experiences suggest that universal ART, and more generally the 90-90-90 UNAIDS targets, will be difficult to achieve without the implementation of new models of health service delivery.Item Human immunodeficiency virus and hepatitis B or C co-infection in KwaZulu-Natal: a retrospective analysis of a laboratory database(SAJEI, 2013-08-22) Jinabhai, Champaklal C.; Tathiah, Nerisha; Parboosing, Raveen; Singh, Lavanya; Moodley, PraviHepatitis B or C virus infection has an important influence on treatment and outcomes in human immunodeficiency virus (HIV)-infected individuals. HIV worsens the prognosis in hepatitis B- or C virus-infected patients, and patients on antiretroviral therapy are more likely to experience hepatotoxicity if they are co-infected with a hepatotropic virus. There is a paucity of data on the epidemiology of hepatotropic viruses in relation to each other and to HIV in KwaZulu-Natal. The aim of this study was to describe the seroprevalence of hepatitis B and C virus in HIV-positive and -negative individuals in KwaZulu-Natal from 2002-2010, using a large laboratory database of routine serological results. Patients who had an HIV or hepatitis B or C test performed at the National Health Laboratory Service Department of Virology in Durban from 2002-2010 were included in the study. The study revealed that the overall seropositivity of hepatitis B surface antigen (HBsAg) was 12.05%, and that of hepatitis C immunoglobulin G (IgG), 4.13%. Individuals who were seropositive for HIV had 3.19-fold increased odds of being positive for HBsAg, 2.06-fold increased odds of being hepatitis B virus e antigen-positive, and 2.91-fold increased odds of being hepatitis C virus IgG-positive. Of those individuals who were tested for HBsAg and hepatitis C virus IgG (irrespective of HIV status), 15.76% were seropositive for both markers. HIV-positive individuals are at increased odds of having markers for hepatitis B and C infection.Item Evaluation of an HIV and AIDS management system at a coal manufacturing company in the KwaZulu-Natal province of South Africa : a case study(Unisa, 2013) Sibiya, Maureen Nokuthula; Odetokun, Joseph; Kgware, M.In South Africa, HIV and AIDS workplace programmes have been implemented for more than two decades without any audited and certifiable standards. In 2007, the South African National Standard (SANS 16001, 2007) was launched to assist, encourage and support companies to implement the minimum standards for the HIV and AIDS Management System (HAMS). Consequently, companies were expected to establish workplace HAMS in line with the set standard, as specified in SANS 16001, assisting companies to establish, implement, maintain and improve their HAMS. A single case study, using a quantitative design was used to evaluate the implementation of the HAMS in a coal-manufacturing company operating in the KwaZulu-Natal Province of South Africa. The sample comprised all consenting participants who were selected from key drivers of workplace HIV and AIDS programmes, in accordance with the requirements of SANS 16001, and the general workers. Two different sets of questionnaires were used to collect data. One questionnaire was used to collect data from the managers because they were key role players in HAMS. The second questionnaire was used to collect data from the general workers. A statistician used both Microsoft Excel and the Statistical Package for Social Sciences (SPPS) version 19 to process and analyse the data. Tables and bar graphs were used to present the results. The results revealed that the company complied with most general requirements as specified by SANS 16601 for HAMS. However, more should to done in terms of training and documentation to ensure compliance with the HAMS.