Faculty of 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 Epidemiological evaluation of circulating levels of Copeptin and Fibronectin during pregnancy(2019-09-05) Deepnarain, Kayshia; Govender, Nalini; Reddy, PoovendhreeBackground: Despite efforts to reduce problems associated with child and maternal health, the United Nations International Children’s Emergency Fund (UNICEF) corporation reported, that low and middle-income countries such as South Africa remains burdened with this issue. Based on this premise and the recent interest in copeptin (CPP) and fibronectin (Fn) as promising biomarkers in pregnancy related disorders, this study aimed to establish baseline levels of CPP and Fn in normotensive pregnancies complicated with HIV. Objectives: The objectives of this study were to determine circulating levels of CPP and Fn together with leucyl/cystinyl aminopeptidase (LNPEP) and cystatin C in normotensive pregnancies and to evaluate the association between these biomarkers and different demographic and clinical parameters (e.g. BMI, BP, Hb levels, maternal age and HIV status) throughout gestation. Methodology: This study stemmed from a previous cohort study conducted between 2015 and 2016 at the Cato Manor Primary Health Care facility in KwaZulu-Natal, South Africa. A total of 41 normotensive pregnant women aged between 18-45 years were selected through convenient sampling and evaluated at 10-20 weeks, 22-30 weeks and 32-38 weeks gestation. Archived serum samples were evaluated using Enzyme Linked Immunosorbent Assays to measure circulating levels of CPP and Fn. Additionally, markers of renal function were evaluated by measuring serum levels of cystatin C and LNPEP. Biomarker profiles and epidemiological and demographic characteristics were quantitatively analysed using STATA (version 15). P<0.05 was considered statistically significant. Results: Among the 41 participants, 28 were HIV positive of which 18 were on the Prevention of Mother to Child Transmission programme. A total of 23 participants were anaemic. Less than half the population were nulliparous and nulligravida. Fluctuations in biomarker concentrations were observed throughout pregnancy with CPP, LNPEP and cystatin C showing an overall decrease between 10 and 38 weeks gestation whilst Fn increased in the second gestational period and then decreased in the third gestational period. Slightly lower recordings were indicated for both systolic and diastolic blood pressures within the HIV positive group, except at gestational period 3, where systolic blood pressure was higher amongst the HIV positive group. On the other hand, haemoglobin levels were higher in the HIV positive group throughout pregnancy. Conclusion: The baseline levels of CPP, Fn, LNPEP and cystatin C measured in this study are expected to be used for comparison or as reference values to identify the presence of pregnancy related disorders in other studies of similar design and control groups.Item Impact of HIV/AIDS scale-up on non-HIV priority services in Nyanza Province, Kenya(2017) Opollo, Valerie Sarah Atieno; Puckree, ThreethambalBackground: The HIV pandemic has attracted unprecedented scale-up in resources to curb its escalation and manage those afflicted. Although evidence from developing countries suggests that public health systems have been strengthened as a result of scale-up, only anecdotes exist in other countries. Despite scale-up, the prevalence of HIV/AIDS is still high and the resultant mortality and morbidity demands a refocus. Furthermore, the HIV/AIDS epidemic has severely strained vulnerable health systems in developing countries leading to concerns among policy makers about non-HIV priority services. Although anecdotally, it is clear that HIV scale-up has had profound effects on health systems, available evidence does not allow for an assessment of the impact of such effects on health care access, service delivery or medical outcomes for non- HIV conditions. The aim of this study was to determine the impact of HIV/AIDS scale-up on non-HIV priority services in the former Nyanza Province, Kenya. Additionally we determined the benefits and detriments of HIV programmes, and identified the elements of successful HIV programs and their effect on scale-up and last but not least determined the perceptions, attitudes and experiences of health care staff towards scale-up and integration of health care services. The first part of the main sequential study reviewed practices during scale-up by looking at public health facilities within the Province at Nyanza in Kenya. This looked at health management information systems (HMIS) and routine health facility client records for five years, 2009-2013 with a comparison of trends in 2009 to that in 2013. This data was reviewed in order to show trends in delivery of HIV priority and non-HIV services. The second part of the study utilized a prospective cross sectional survey to determine perceptions, attitudes and experiences xi of facility personnel towards HIV/AIDS scale up. Randomly sampled facilities involved in the delivery of any aspects of HIV diagnosis care and treatment were investigated. Self-administered questionnaires and in-depth interviews were used to obtain information on impact of HIV services on non-HIV priority services on health managerial staff in the facilities and key informants who have shaped scale up. We created a qualitative codebook based on three major themes identified from the data: (1) Meaning and importance of HIV scale-up (2) Perspectives of scale-up on service delivery on non-HIV services and (Ministry of State for Planning) Health facility staff awareness. The findings indicate that the interventions that were utilized in the scale-up of HIV in 2009 resulted in significant increases in uptake of the service in 2013 (p<0.01) and total integration of HIV and non-HIV services at all the health facilities thereby contributing to improved health outcomes beyond those specifically addressed by HIV programs. This study has also shown that utilization of both HIV and non-HIV services increased significantly for both years after integrated HIV care was introduced in the health facilities (p<0.01). Notable increases were found for ANC utilization (p=0.09), family planning (p=0.09), screening for tuberculosis and malaria (p<0.01) and provision of support services (p<0.01) to HIV infected people. The scale up of HIV in the region had several human resource policy implications resulting from staff turnover and workload. Stakeholder engagement and sustainability are critical in the sustenance of these initiatives. Strategic alliances between donors, NGOs and the government underpinned the scale-up process. Policies around scale-up and health service delivery were vital in ensuring sustainability of scale- up and service integration. This study has attempted to provide evidence on the impact of HIV scale-up on non-HIV service delivery in three different settings, in two different time periods and it therefore concludes that the evidence is mixed with most of the impact being positive with some aspects that still needs development. It is critical to pursue the integration of HIV and non- HIV services in a strategic and systematic manner so as to maximize the public health impact of these efforts. The proposed model, best practices and practices requiring improvement will be communicated to the relevant ministries to ensure its integration into policy.Item 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.Item Placental leptin mRNA expression and serum leptin levels in pre-eclampsia associated with HIV infection(Taylor and Fancis Online, 2016-10-03) Haffejee, Firoza; Naicker, Thajasvarie; Singh, Moganavelli; Kharsany, Ayesha B.M.; Adhikari, Miriam; Singh, Ravesh; Maharaj, Niren; Moodley, JagidesaLeptin, primarily produced by adipocytes, is implicated in the development of pre-eclampsia. This study examines placental leptin production and serum leptin levels in HIV infected and uninfected normoten-sive and pre-eclamptic pregnancies. Placental leptin production was analysed by RT-PCR and serum lep-tin levels by ELISA in normotensive (n ¼ 90) and pre-eclamptic (n ¼ 90) pregnancies which were further stratified by HIV status. Placental leptin production was higher in pre-eclampsia compared to normoten-sive pregnancies irrespective of HIV status (p ¼ .04). Serum leptin was non-significantly raised in HIV uninfected (p ¼ .42) but lower in HIV-infected (p ¼ .03) pre-eclampsia. The latter had lower BMI (p ¼ .007) and triceps skin-fold thickness (p < .001) than the HIV uninfected groups with a significant correlation between serum leptin and triceps skin-fold thickness (p < .001), indicative of less adipose tissue in HIV-infected women with consequently lower serum leptin. Thus, serum leptin levels are not indicative of increased placental production when pre-eclampsia is associated with HIV infection.Item Endoglin in HIV-associated preeclamptic placentae(Informa Healthcare, 2015) Govender, Nalini; Naicker, Thajasvarie; Moodley, JagidesaObjective: To examine the placental immunoexpression of endoglin (Eng), in HIV-negative and HIV-positive normotensive (N and N+) and preeclamptic (P and P+) pregnancies at term, using immunohistochemistry and immunoelectron microscopy. Results: Strong Eng immunoreactivity was observed within endothelial cells, syncytio-and cyto-trophoblast cell populations. All extravillous trophoblast cells were immuno-positive for Eng. Subcellularly, gold particles were immunolocalised within the endoplasmic reticulum, and mitochondria. Immunoexpression of Eng differed signifi-cantly between exchange (p = 0.02) and conducting villi (p50.001). A higher Eng immunoexpression was observed in both villi types of the preeclamptic compared to normotensive groups. Irrespective of pregnancy type (normotensive versus PE), there was no significant effect of HIV status on Eng immunoexpression within the exchange and conducting villi. Conclusion: The immunostaining of Eng within the endothelial cells, syncytio-, cyto- and extravillous trophoblast cell populations of HIV-associated preeclamptic placentae is novel. Endoglin and its soluble component remains an area for dynamic placental exploration in preeclampsia development.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.