Faculty of Health Sciences
Permanent URI for this communityhttp://ir-dev.dut.ac.za/handle/10321/11
Browse
4 results
Search Results
Item Development of an HIV risk index for university students in KwaZulu-Natal, South Africa(2024) Pillay, Trishka; Reddy, Poovendhree; Govender, NaliniBackground: Human Immunodeficiency Virus (HIV) infection is a global health challenge, with developing countries most affected by the HIV burden. In South Africa (SA), young people aged 15 to 24 years are exceptionally vulnerable to HIV infection. University students are a segment of this vulnerable age group in SA. Significant effort and resources have been invested in HIV prevention and treatment such as availability of free government issue condoms, a large-scale antiretroviral (ARV) programme and intensification of other public health interventions such as male medical circumcision (MMC) and the availability of Pre exposure prophylaxis (PrEP). Nonetheless, HIV still poses a critical public health challenge 40 years post discovery, particularly among young people. Factors that may increase susceptibility include substance usage, tendency to engage in risky sexual behaviours (RSBs) such as transactional sex, inconsistent condom usage and engaging in sex with multiple partners. Poverty may further perpetuate RSBs such as transactional sex for money or to acquire basic needs. University students form part of the country’s economic backbone and are the future leaders of the country, thus context driven HIV prevention interventions for this unique population are imperative. HIV risk is multidimensional and in order to develop effective prevention interventions, risk factors associated with RSBs and HIV seropositivity must be further explored. Aim: The study aimed to analyse the behavioural and socio-economic components of risk associated with HIV and health among student populations in an attempt to design an evidence based risk index. Methodology: This study used a case control study design. Study sites included the four major public sector higher educational institutions (HEIs) in KwaZulu-Natal, South Africa. A structured questionnaire was used to collect data using convenience sampling from the study population with consisted of 375 HIV uninfected students (controls) and 125 HIV infected students (cases). STATA-version 17 was used to conduct data analysis. Data collected from controls was initially used to conduct a preliminary analysis to explore the association between food insecurity which was a socio-economic risk factor and RSBs. Subsequently, the main analysis was undertaken to investigate associations of the following: socio-economic, behavioural and knowledge risk factors with RSBs and HIV seropositivity using bivariate analysis and logistic regression modelling. Results from the case control data analysed was used to develop an HIV risk index tool, for specific use among university students. Key findings: Preliminary data analysis of control data found significant associations between food insecurity and students engaging in transactional sex for money as well as to meet basic needs. Participants who were food insecure were twice as likely to have multiple sexual partners. The case control analysis with socio-economic risk factors revealed a significant association between socio-economic measures, RSBs and HIV seropositivity. Overall, food insecurity increased the likelihood of multiple partners, transactional sex for money, and transactional sex for basic needs. Students who accessed the government funding scheme and shared the bursary/ loan were more likely to be HIV seropositive. Results from the analysis on behavioural risk factors indicated that heavy episodic drinking [aOR: 2.73 (1.38; 5.44), 0.004], drugs before sex [aOR: 7.46 (2.11; 27.88), 0.003], and a higher number of lifetime sex partners (2 to 5 partners) [aOR: 4.22(1.69; 10.54), 0.002] and ≥ 6 partners [aOR: 16.36 (6.18; 43.28), 0.000] increased students’ likelihood of having multiple concurrent sex partners. High risk behaviours such as sex with multiple partners and inconsistent condom use were more prevalent among HIV uninfected students. Data from our study showed that both HIV infected, and uninfected students displayed a better understanding regarding modes of HIV transmission compared to prevention methods. Students with poor knowledge regarding HIV prevention were 2.34 times more likely to be HIV positive and those demonstrating poor knowledge about HIV transmission were 4.79 times more likely to be HIV positive. Several misconceptions regarding HIV transmission methods were prevalent among both HIV infected and uninfected students. The above findings regarding socio-economic, behavioural and knowledge risk factors were used to develop an HIV risk index tool based on logistic regression models. The risk index score comprises 17 factors and used an aggregated score to formulate three risk categories namely, low, medium, and high-risk categories. Questions were formulated for the risk index tool based on variables used in the data analysis. Conclusion: Our findings demonstrate that university students are at an increased risk of engagement in RSBs which may consequently lead to HIV infection. Therefore, it is of critical importance for public health officials to consider the multidimensional aspects of HIV risk in the university student population when designing interventions targeted at this vulnerable group. Risk measurement is important to guide HIV prevention methods such as Pre-exposure prophylaxis (PrEP). The developed risk index tool has the potential to serve as a powerful public health tool for measurement of HIV risk among university students in developing countries. However, further testing and evaluation is required before implementation.Item Provision of HIV testing services and its impact on the HIV positivity rate in the public health sector in KwaZulu-Natal : a ten-year review(Informa UK Limited, 2024-12) Desai, Rizwana; Onwubu, Stanley; Lutge, Elizabeth; Buthelezi, Nondumiso Patience; Moodley, Nirvasha; Haffejee, Firoza; Segobe, Bontle; Krishna, Suresh Babu Naidu; Sibiya, Maureen Nokuthula; Jinabhai, Champaklal ChhaganlalSouth Africa has been rated as having the most severe HIV epidemic in the world since it has one of the largest populations of people living with HIV (PLHIV). KwaZulu-Natal (KZN) is the epicentre of the HIV epidemic. The HIV test and treat services in the public health sector are critical to managing the epidemic and responding to the increase in HIV infections. The KwaZulu-Natal Department of Health (DOH) commissioned a review of the provision of HIV testing services in the province and aimed to investigate its impact on the HIV positivity rate over a ten-year period. The study was an ecological study design using data extracted from the Department's District Health Information System (DHIS). Descriptive analysis was conducted in addition to ANOVA and multiple regression analysis. The results of this study have shown that the total number of HIV tests conducted over the ten-year period in the province has increased with the highest number of HIV tests being conducted in the 2018/2019 MTEF year. ANOVA analysis indicates that there was a statistically significant difference in the total number of HIV tests conducted and the number of HIV tests per 100 000 population across the province's 11 districts (p < 0.001). Statistically significant differences were observed in the HIV testing rate and in the HIV positivity rate over the period (p < 0.001). Results from multiple regression analysis showed that the HIV testing rate per 100 000 population was the strongest predictor of the HIV positivity rate. HIV positivity among clients correlated negatively with the number of HIV tests conducted per 100 000 population (r = -0.823; p < 0.001) and the HIV testing rate (r = -0.324; p < 0.01). This study has found that HIV testing could have an impact on reducing the positivity rate of HIV in the province and is therefore an effective strategy in curbing the HIV epidemic. The KwaZulu-Natal Department of Health should ensure that strategies for implementing and maintaining HIV testing and treating services should continue at an accelerated rate in order to achieve the first 95 of the UNAIDS 2025 SDG target.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 A qualitative exploration into the presence of TB stigmatization across three districts in South Africa(Springer Science and Business Media LLC, 2023-03-15) DeSanto, Daniel; Velen, Kavindhran; Lessells, Richard; Makgopa, Sewele; Gumede, Dumile; Fielding, Katherine; Grant, Alison D.; Charalambous, Salome; Chetty-Makkan, Candice M.Tuberculosis (TB) stigma is a barrier to active case finding and delivery of care in fighting the TB epidemic. As part of a project exploring different models for delivery of TB contact tracing, we conducted a qualitative analysis to explore the presence of TB stigma within communities across South Africa.Methods
We conducted 43 in-depth interviews with 31 people with TB and 12 household contacts as well as five focus group discussions with 40 ward-based team members and 11 community stakeholders across three South African districts.Results
TB stigma is driven and facilitated by fear of disease coupled with an understanding of TB/HIV duality and manifests as anticipated and internalized stigma. Individuals are marked with TB stigma verbally through gossip and visually through symptomatic identification or when accessing care in either TB-specific areas in health clinics or though ward-based outreach teams. Individuals' unique understanding of stigma influences how they seek care.Conclusion
TB stigma contributes to suboptimal case finding and care at the community level in South Africa. Interventions to combat stigma, such as community and individual education campaigns on TB treatment and transmission as well as the training of health care workers on stigma and stigmatization are needed to prevent discrimination and protect patient confidentiality.