Research Articles (School of Health Systems and Public Health (SHSPH))

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Associating serum testosterone levels with African ancestral prostate cancer health disparities
(Nature Research, 2025-04) Lebelo, Maphuti Tebogo; Mmekwa, Naledi; Louw, Melanie; Jaratlerdsiri, Weerachai; Mutambirwa, Shingai B.A.; Loda, Massimo; Hayes, Vanessa M.; Bornman, Maria S. (Riana); riana.bornman@up.ac.za
Serum testosterone levels decrease in the aging male, while the risk for prostate cancer (PCa) increases concomitantly. Higher levels in younger men have been linked with racially driven PCa disparities, with African men disproportionately impacted. In turn, higher levels of serum lipids have been associated with aggressive disease, while racial disparity between serum testosterone, cholesterol and cancer mortality has been suggested. Having previously reported a 2.1-fold increased age-adjusted risk for aggressive PCa in Black South African over Black American men, we determined the serum testosterone and associated lipid levels in 250 Black South African men either with or without clinicopathologically diagnosed disease. Observing no associations with serum lipid levels, Black South Africans presented with testosterone levels between 1.24 (< 60 years) and 1.3-fold (≥ 60 years) greater than Black Americans. Notably, a rapid drop in total-, bioavailable- and free testosterone levels in men 65 years or older was significantly associated with PCa risk (P = 0.0057, 0.009 and 0.005, respectively), while irrespective of age, further associated with advanced disease (P = 0.004, 0.0012 and 0.0036, respectively). These preliminary data provide insights into the potential role of androgens in driving PCa health disparities, with important consequence for tailoring treatment for Black men.
Assessing user experience with the Bioline™ HCV point-of-care test in primary healthcare settings : a mixed-methods study
(BioMed Central, 2025-04) Duah, Evans; Mathebula, Evans Mantiri; Maluleke, Kuhlula; Baloyi, Tinyiko Violet; Ephraim, Richard Kobina Dadzie; Mashamba-Thompson, Tivani Phosa; evans.duah@tuks.co.za
BACKGROUND : Hepatitis C Virus (HCV) is a major public health challenge, particularly in resource-limited settings with inadequate diagnostic services. The Bioline™ HCV Point-of-Care (POC) test provides a promising solution for improving diagnosis in Primary Healthcare (PHC) clinics without laboratory infrastructure. This study evaluated the test’s usability, acceptability, and deliverability in Ghana using user-oriented REASSURED criteria. METHODS : A convergent parallel mixed-methods design was adopted. Quantitative data was collected through direct observation of Healthcare Workers (HCWs) using audit checklists and analyzed with Stata 16. The analysis included descriptive statistics, inter-rater concordance assessment, and the application of the System Usability Scale (SUS). Qualitative data, analyzed using Atlas.ti 24.2.0, explored user experiences, confidence, storage infrastructure, and suggestions for test design improvement through in-depth interviews. RESULTS : The quantitative audit included 81 non-laboratory HCWs, with 22 participating in in-depth interviews. The test scored 88.7 on the SUS (95% CI: 86.40-90.88), with 88% of HCWs rating it as easy or very easy to use. Most HCWs (81.5%) successfully completed all testing steps independently, achieving 100% inter-rater concordance, but 83% made errors in at least one step, primarily during pre-testing. Qualitative findings revealed widespread acceptance, confidence, and adaptability despite challenges with storage infrastructure. DISCUSSION : The Bioline™ HCV POC test demonstrated high usability and acceptance among HCWs in resource-limited settings. Enhancements such as improved packaging, simplified information sheets, refined droppers, and additional components like gloves could further optimize usability. These findings support the Sustainable Development Goal (SDG) 3 by enhancing access to timely HCV diagnosis, contributing to Universal Health Coverage, and strengthening health systems in underserved areas. TRIAL REGISTRATION : This study is part of a diagnostic trial registered in the Pan African Clinical Trial Registry (https://pactr.samrc.ac.za) on 24th October 2024 with trial registration number: PACTR202410837698664.
The long wait for long-acting HIV prevention and treatment formulations
(Elsevier, 2024-10) Venter, Willem Daniel Francois; Gandhi, Monica; Sokhela, Simiso; Sikwese, Kenly; Bygrave, Helen; Da Gama, Louis; Mphothulo, Ndiviwe; Jamieson, Lise; Siedner, Mark J.; Pozniak, Anton L.; Rojo, Pablo; Baptiste, Solange L.; Wambui, Jacque; Meyer-Rath, Gesine; Honermann, Brian; Warren, Mitchell; Bekker, Linda-Gail; Sinxadi, Phumla; Collins, Simon; Burry, Jessica; Moller, Karlien; Clayden, Polly; Owen, Andrew; Hill, Andrew
Large randomised studies of new long-acting medications for the prevention and treatment of HIV have shown high effectiveness and acceptability. Although modelling studies indicate these agents could be fundamental in HIV elimination, coordination of their entry into health-care markets is crucial, especially in low-income and middle-income countries with high HIV prevalence, where coordination is low despite UNAIDS flagging that global HIV targets will not be met. Research and implementation projects are tightly controlled by originator pharmaceutical companies, with only a small percentage of eligible people living with or affected by HIV benefiting from these projects. WHO, financial donors, manufacturers, and governments need to consider urgent coordinated action from stakeholders worldwide, akin to the successful introduction of dolutegravir into treatment programmes across low-income and middle-income countries. Without this immediate coordination, large-scale access to long-acting agents for HIV will be delayed, potentially extending into the 2030s. This delay is unacceptable considering the established global HIV targets.
'We do not like talking about our problems' : socialization and idealized masculinity as drivers of help-seeking avoidance among college men in South Africa
(BioMed Central, 2025-03) Sikweyiya, Yandisa; Mahlangu, Pinky; Jewkes, Rachel; Brooke-Sumner, Carrie; Gibbs, Andrew; Dartnall, Elizabeth; Pillay, Managa; Machisa, Mercilene
BACKGROUND : This article explores how identities and contexts influence help-seeking avoidance behaviour among college men. METHODS : This exploratory qualitative study purposively selected 88 male students (aged 18–30) from some universities and Technical and Vocational Training colleges (TVETs) in South Africa. Data were collected through focus group discussions (FGDs). Eight FGDs were conducted, one in each selected university (n = 2) and TVETs (n = 6) in 2018–2019. Data were analyzed using a thematic analysis approach. RESULTS : We found that college men’s early life experiences and socialisation strongly influenced their ability to express emotion and access services when in need of help. The data also revealed a masculinity that men aspired to and wanted to be seen as embracing or personifying while on campus. Most men ascribed to an ideal of masculinity that made it difficult for them to share their feelings (e.g., emotional pain, sadness; and bottle their emotions) and seek help from campus-based counselors or peers. The few men who reported using campus mental health support services appraised them as unsuitable and unhelpful for them, and indicated a preference for services that were more culturally relevant. Most men indicated a preference for male counselors, of which there were very few. CONCLUSIONS : These findings may be useful for the formulation of evidence-based context-specific and culturally sensitive approaches for increasing men’s access to mental health and psychological support services on South African college campuses.
Higher genotyping performance of the applied biosystems TaqPath Seq HIV-1 genotyping kit against ViroSeq HIV-1 genotyping Kit in HIV protease, reverse transcriptase, and integrase regions
(Dove Press, 2025-04) Choga, Ontlametse Thato; Okafor, Obiageli; Lemogang, Goitseone Martha; Choga, Wonderful Tatenda; Muzanywa, Gaonyadiwe; Garcia, Andrea E.; Moyo, Sikhulile; Gaseitsiwe, Simani
PURPOSE : We assessed the performance of Applied Biosystems TaqPath Seq HIV-1 Genotyping Kit (CE-IVD) (TaqPath Kit) against the ViroSeq HIV-1 Genotyping Assays in genotyping HIV protease (PR), reverse transcriptase (RT), and integrase (INI) regions. METHODS : The study included 43 HIV-1 plasma specimens: 20 from people living with HIV-1C and 23 well-characterized HIV-positive Virology Quality Assurance (VQA) samples with PR-, RT-, and INI mutations. VQA samples included HIV-1 subtypes A, B, C, D, F, G, CRFO2_AG and URF. HIV-1 RNA extracted from all specimens was tested with both genotyping assays. Known HIV drug resistance mutations (DRMs) were identified using the Stanford HIV drug resistance database. Sequencing success rates, nucleotide identity, and DRMs from the two commercial assays were compared. RESULTS : Of 43 samples, TaqPath Kit amplified 93.0% (40) for HIV PR/RT and 97.7% (42) for HIV INI regions, compared to ViroSeq Assays, which amplified 69.8% (30) and 72.1% (31) for PR/RT and INI, respectively. The TaqPath Kit successfully sequenced 90.0% (36/40) PR/RT and 97.6% (41/42) INI amplicons, while ViroSeq Assays sequenced 53.3% (16/30) PR/RT and 87.1% (27/31) INI amplicons. The mean nucleotide similarity was 98.8% (SD ± 1.30), 99.6% (SD ± 1.32) and 99.2% (SD ± 0.72) for paired RT, PR and INI sequences, respectively. The TaqPath Kit detected 97.2% (35/36) of DRMs identified by the ViroSeq Assays and an additional 83 mutations and polymorphisms in samples that failed genotyping with the ViroSeq Assays. Among these, 85.5% (71/83) were confirmed by the reference sequence, including 39 major DRMs. CONCLUSION : The TaqPath Kit demonstrated higher genotyping performance compared to the ViroSeq assays. The TaqPath Kit was able to detect DRMs in the PR, RT and INI regions of various HIV-1 subtypes, offering a critical tool to identify and monitor HIV drug resistance to new and existing antiretroviral drugs targeting these regions.
Impact of US funding cuts and stop work orders on TB services and research in South Africa
(International Union Against Tuberculosis and Lung Disease, 2025-04-09) Ndjeka, N.; Kubjane, M.; Abdullah, Fareed; Mohr-Holland, E.; Subrayen, P.; Loveday, M.; Dube, M.; Boffa, Jody
No abstract available.
Assessing socioeconomic inequality in ageing in sub-Saharan Africa : an empirical assessment of South Africa
(Springer, 2025) Ataguba, John E.
The population younger than 5 years is now exceeded by those older than 65 globally, with women making up a larger share. Because ageing was traditionally about people older than 60 or 65, Africa, with a predominantly younger population under 50 years, was previously not a focus of ageing research. However, shifting the focus away from people older than 65, a concept without concrete meaning in many African settings, this paper considers ageing a continuous process. It assesses socioeconomic inequalities in ageing and gaps in gender-related socioeconomic disparities in ageing in Africa using South Africa as a case study. Data come from four rounds of nationally representative general household surveys spanning 2003–2018. Using the concentration index to assess socioeconomic inequalities in ageing, a significantly large proportion of younger populations comes from poorer households, while the reverse is the case for older adults. There is a gendered pattern in socioeconomic inequality in ageing. While there are no significant differences in socioeconomic inequalities in ageing between boys and girls aged 0–9 years, socioeconomic disparities become apparent and significantly “favour” males in much older groups, say 60 years and above. The paper highlights the importance of multisectoral action and a gendered approach in addressing the significant socioeconomic inequalities in ageing. While further research is needed to understand key drivers of inequalities, mainstreaming ageing into multisectoral policies, especially prioritising younger women, is necessary to build up resources to reduce socioeconomic disparities in ageing at older ages in South Africa.
Women's experience of preterm birth in an East African context : a qualitative study
(Makerere University, Medical School, 2024-03-01) Habtu, Thomas Asmelash; Pembe, Andrea Barnabas; Chiwanga, Faraja S.; Odland, Jon Oyvind; Darj, Elisabeth
BACKGROUND: Approximately 15 million children are born each year prematurely, representing more than 10 percent of all childbirths worldwide. Prematurity is an acute event and the leading cause of death among newborns and children under five. Sixty percent of these premature deaths occur in Sub-Saharan Africa and Southeast Asia. OBJECTIVE: The current study aimed to explore and understand women’s experiences and perceptions regarding giving birth prematurely at the National Hospital of Muhimbili in Dar es Salaam, Tanzania. METHOD: A qualitative method, using Interpretive Phenomenological Analysis approach was chosen to understand and describe the women’s experiences. A semi-structured guide was used during the interviews. All interviews were audio-recorded and transcribed verbatim. FINDINGS: Eight in-depth interviews were conducted. The analysis revealed three superordinate themes: (a) Emotional turmoil: unmet expectations shattering maternal identity, emotional distress, and loss of hope; (b) Adapting to preterm birth and challenges: the unexpected situation, lack of proper care, strenuous breastfeeding routines, and socioeconomic challenges; (c) Significance of proper care and emotional support: good maternal care, mother-to-mother and family support. CONCLUSION: This study provided a deeper understanding of women’s experiences and perceptions of premature childbirth. The current study indicated the importance of caregivers’ awareness of the women’s emotional distress, their need to adapt to a sudden unexpected situation, and the necessity of emotional support.
The integrated care costs of HIV and non-communicable diseases in South Africa
(International Union Against Tuberculosis and Lung Disease, 2024-12-01) Moyo-Chilufya, Maureen; Mgutshini, Tennyson; Musekiwa, Alfred; Hongoro, Charles; u21572152@tuks.co.za
SETTING: In sub-Saharan Africa, the syndemic of HIV and non-communicable diseases (NCDs) poses a significant challenge. To address this, leading global think tanks like the WHO advocate for integrated HIV/NCD care at primary healthcare levels. However, comparative empirical data on the costs of integrated care are limited. South Africa, with the largest HIV programme globally, was purposively selected for our comparative case study. OBJECTIVE: To determine the cost of integrated HIV/ NCD care from the providers’ perspective at two ‘ideal status’ public healthcare facilities in South Africa as case studies. DESIGN: A multi-pronged methodology was used to collect provider cost data via retrospective documentary sources or records and a question-and-answer session with facility managers who provided key information on costrelated data. Data analysis utilised an activity-based costing (ABC) method. RESULTS: Despite the difference in the size of the clinics, the cost per patient in terms of ABC is similar between the two primary healthcare facilities, USD261.60 and USD226.30, respectively. CONCLUSION: The ABC method can be utilised to cost integrated care, foster health economic data availability for future research, and inform health policymakers.
Comparing pill counts and patient self-reports versus DBS tenofovir concentrations as ART adherence measurements with virologic outcomes and HIV drug resistance in a cohort of adolescents and young adults failing ART in Harare, Zimbabwe
(Elsevier, 2024-09) Mtisi, Takudzwa J.; Kouamou, Vinie; Morse, Gene D.; Dzinamarira, Tafadzwa; Ndhlovu, Chiratidzo E.; u19395419@up.ac.za
BACKGROUND : Monitoring adherence presents a challenge in adolescents and it is prudent to explore several options for determining their level of adherence. This study sought to determine ART adherence levels in adolescents and young adults (on a tenofovir-containing regimen) failing ART as measured by self-reports, pill counts and DBS tenofovir concentrations and to compare levels of agreement among the methods and determine the ability of each method to predict virological suppression. METHODS : This was a cohort study involving 107 adolescents and young adults between 10 and 24 years failing ART with viral load > 400copies/ml at enrolment. Pill count (PC) records, self-reports (SR) and DBS tenofovir concentrations (done by liquid Chromatography with tandem mass spectrometry (LC-MS/MS)) were used to determine adherence in adolescent participants failing ART in Harare. The latter was used as the reference method with a cut-off of 64 ng/ml. Determination of DBS tenofovir concentrations was also performed to rule out inadequate viral response due to low cumulative drug exposure despite high adherence (≥90 %). Longitudinal analysis was performed to determine the correlation of viral loads (VL) with adherence. The Kappa (k) coefficient was used to evaluate the level of agreement among the 3 methods. RESULTS : Poor level of agreement was found between PC records and DBS tenofovir concentrations (k = -0.115). Moderate agreement was found between DBS and SR methods (k = 0.0557). Slight agreement was found between PC and SR methods (k = 0.0078). Adherence was dependent on age at HIV diagnosis (p = 0.0184) and ART initiation (p = 0.0265). Participants who were adherent were six times more likely to be suppressed at end point than their non-adherent counterparts (OR=5.7 CI 2.1 - 16.5, p < 0.0001). CONCLUSIONS : Self-reported measure of adherence and pill counts exhibited poor agreement with the reference method used i.e. DBS tenofovir concentrations and are thus not effective methods of predicting virological suppression.
Genetic variants associated with dengue hemorrhagic fever. A systematic review and meta-analysis
(Elsevier, 2024-04) Kanan, Mohammed; Naffaa, Mohammed; Alanazi, Ahmed; Nasser, Faiz; Alsaiari, Ahad Amer; Almehmadi, Mazen; Assiry, Ali; Muzafar, Hisham; Katam, Hejab; Arar, Abdullah; Asdaq, Syed Mohammed Basheeruddin; Abida; Imran, Mohd.; Dzinamarira, Tafadzwa; u19395419@up.ac.za
Dengue hemorrhagic fever (DHF) is a severe condition resulting from the dengue virus, with four serotypes known as DEN-1, DEN-2, DEN-3, and DEN-4. Genetic variations play a crucial role in influencing susceptibility to DHF. Therefore, this investigation conducted a meta-analysis to uncover genetic changes that might have remained undetected in individual studies due to small sample sizes or methodological differences. Among 2212 initially identified studies, 23 were deemed suitable for analysis based on PRISMA guidelines. Toll-like receptors (TLR) and CD209 showed significant association with DHF (odds ratios: TLR=0.56, CD209 =0.55), indicating protective effects. However, tumor necrosis factor (TNF) and human leukocyte antigen (HLA) did not exhibit a statistically significant relationship with DHF. This study emphasizes the relevance of TLR and CD209 in DHF susceptibility and resistance across diverse geographical locations.
Enteropathogenic viruses associated with acute gastroenteritis among African children under 5 years of age
(Elsevier, 2024-06) Omatola, Cornelius Arome; Ogunsakin, Ropo Ebenezer; Onoja, Anyebe Bernard; Okolo, Martin-Luther Oseni; Abraham-Oyiguh, Joseph; Mofolorunsho, Kehinde Charles; Akoh, Phoebe Queen; Adejo, Omebije Patience; Idakwo, Joshua; Okeme, Therisa Ojomideju; Muhammed, Danjuma; Adaji, David Moses; Samson, Sunday Ocholi; Aminu, Ruth Foluke; Akor, Monday Eneojo; Edegbo, Emmanuel; Adamu, Andrew Musa
Gastroenteritis viruses are the leading etiologic agents of diarrhea in children worldwide. We present data from thirty-three (33) eligible studies published between 2003 and 2023 from African countries bearing the brunt of the virus-associated diarrheal mortality. Random effects meta-analysis with proportion, subgroups, and meta-regression analyses were employed. Overall, rotavirus with estimated pooled prevalence of 31.0 % (95 % CI 24.0–39.0) predominated in all primary care visits and hospitalizations, followed by norovirus, adenovirus, sapovirus, astrovirus, and aichivirus with pooled prevalence estimated at 15.0 % (95 % CI 12.0–20.0), 10 % (95 % CI 6–15), 4.0 % (95 % CI 2.0–6.0), 4 % (95 % CI 3–6), and 2.3 % (95 % CI 1–3), respectively. Predominant rotavirus genotype was G1P[8] (39 %), followed by G3P[8] (11.7 %), G9P[8] (8.7 %), and G2P[4] (7.1 %); although, unusual genotypes were also observed, including G3P[6] (2.7 %), G8P[6] (1.7 %), G1P[6] (1.5 %), G10P[8] (0.9 %), G8P[4] (0.5 %), and G4P[8] (0.4 %). The genogroup II norovirus predominated over the genogroup I-associated infections (84.6 %, 613/725 vs 14.9 %, 108/725), with the GII.4 (79.3 %) being the most prevalent circulating genotype. In conclusion, this review showed that rotavirus remains the leading driver of viral diarrhea requiring health care visits and hospitalization among under-five years children in Africa. Thus, improved rotavirus vaccination in the region and surveillance to determine the residual burden of rotavirus and the evolving trend of other enteric viruses are needed for effective control and management of cases.
Mortality trends and causes of death in a South African hospital complex pre- and during COVID-19
(AOSIS, 2025-03) Tshabalala, Khanyisile; Fabris-Rotelli, Inger Nicolette; Basu, Debashis; Myburgh, Magriet; Abdullah, Fareed; khanyisile.tshabalala@ up.ac.za
BACKGROUND : Before coronavirus disease 2019 (COVID-19), global health was improving, with declining mortality trends. The pandemic disrupted this progress, increasing mortality in South Africa between April 2020 and March 2022. Pre-pandemic data establishes a baseline for assessing COVID-19’s impact on all-cause mortality. OBJECTIVES : This study examines changes in hospital-based mortality trends in a Gauteng hospital complex from April 2018 to March 2022, addressing the scarcity of such studies during the COVID-19 era. METHOD : A retrospective review of 7815 deaths from April 2018 to March 2022 was conducted. Chi-squared tests were used to analyse deaths by age group and gender, with correlations reported. RESULTS : Mortality rates rose from 3.2% in 2018–2019, peaked at 5.1% in 2020–2021, and declined to 4.2% in 2021–2022. Patients aged 15 years–64 years had the highest death rates, with an increase among those over 65. Male deaths exceeded female deaths, with the smallest difference observed in 2020–2021. Leading causes of death included diseases of the circulatory and respiratory systems, neoplasms, digestive system diseases, and infectious and parasitic diseases. CONCLUSION : The study highlights COVID-19’s impact on mortality, showing variations by year, age, gender, and disease. Contribution: Excess non-COVID-19 deaths likely stemmed from disrupted healthcare services. These findings underscore the need for ongoing monitoring of hospital mortality to identify pandemic-related service disruptions and guide interventions to strengthen healthcare services, improve access to care, and enhance referral systems during unexpected disasters.
Effective cervical cancer prevention in sub-Saharan Africa needs the inclusion of men as key stakeholders
(Frontiers Media, 2025-01) Dzobo, Mathias; Dzinamarira, Tafadzwa
Cervical cancer is a major public health problem in low-middle-income countries, especially in sub-Saharan Africa. Strategies for cervical cancer prevention are multi-sectorial, often involving many stakeholders. However, male engagement is still not fully embraced. Involving men in cervical cancer prevention can potentially increase access to prevention services and promote health equity among women. Men’s involvement can overcome barriers to women’s access to preventive services and increase community awareness of cervical cancer prevention.
High prevalence of reverse transcriptase inhibitors associated resistance mutations among people living with HIV on dolutegravir-based antiretroviral therapy in Francistown, Botswana
(Oxford University Press, 2025-03) Choga, Ontlametse T.; Lemogang, Goitseone M.; Choga, Wonderful T.; Muzanywa, Gaonyadiwe; Shadreck, Thembinkosi M.; Ralegoreng, Charity; Maruapula, Dorcas; Moraka, Natasha O.; Koofhethile, Catherine K.; Mokgethi, Patrick T.; Seru, Kedumetse; Zuze, Boitumelo J.L.; Montshosi, Patience; Gobe, Irene; Motswaledi, Modisa S.; Musonda, Rosemary; Mbulawa, Mpaphi B.; Makhema, Joseph; Shapiro, Roger; Lockman, Shahin; Chebani, Tony; Nawa, Judith; Bochena, Lindani; Moyo, Sikhulile; Gaseitsiwe, Simani
OBJECTIVES : We assessed HIV-1 drug resistance profiles among people living with HIV (PLWH) with detectable viral load (VL) and on dolutegravir-based antiretroviral therapy (ART) in Botswana. METHODS : The study utilised available 100 residual HIV-1 VL samples from unique PLWH in Francistown who had viraemia at-least 6 months after initiating ART in Botswana’s national ART program from November 2023 to January 2024. Viraemia was categorized as low-level viraemia (LLV) (VL: 200–999 copies/mL) or virologic failure (VF) (VL ≥1000 copies/mL). HIV-1 protease, reverse transcriptase and integrase genes were sequenced using an in-house next-generation sequencing Oxford nanopore technology. HIV-1 drug resistance mutations (DRMs) were identified using the HIVdb Program in the Stanford HIV drug resistance database and compared between VL groups. RESULTS : Among 100 participants, 83.0% were on dolutegravir-based, 10.0% were on non-dolutegravir-based ART and 7.0% had unknown/undocumented ART regimens. Thirty (30%) participants had LLV and 70 (70%) had VF. Among 58 successfully sequenced, 32.8% [95% Confidence Interval (CI): 21.8–46.0] had DRMs to any drug class, 33.3% (4/12) in the LLV group and 32.6% (15/46) in the VF group. Among individuals on dolutegravir-based ART, the overall HIV DRMs were 34.8% (95% CI: 22.7–49.2). By VL groups, 40.0% (95% CI: 16.8–68.7) and 33.3% (95% CI: 20.2–50.0) had DRMs at LLV and VF, respectively. CONCLUSIONS : A high but similar prevalence of any DRMs was observed among individuals with LLV and those with VF on dolutegravir-based therapy. Monitoring DRMs in individuals with detectable VL is crucial for preserving dolutegravir-based ART.
Navigating the complexities of HIV prevention for adolescents and young persons : a science-to-program and systems approach
(MDPI, 2025-03) Dzinamarira, Tafadzwa; Moyo, Enos; Murewanhema, Grant
This opinion paper dives into the crucial but challenging space of HIV prevention for adolescents and young persons (AYPs). While their vulnerabilities may be heightened, so too is their potential for resilience, innovation, and positive change. To safeguard their health and empower them to make informed choices, a comprehensive science-to-program and systems approach to HIV prevention is paramount. Recognizing their unique vulnerabilities and immense potential, these authors advocate for a multifaceted approach that bridges the gap between scientific evidence and program implementation within a robust healthcare system. This opinion unpacks how leadership, governance, health policies, human resources, health information systems, and HIV surveillance can be strengthened to create a supportive ecosystem where AYPs have the knowledge, resources, and services they need to thrive. This collective effort, involving policymakers, healthcare providers, educators, and AYPs themselves, is critical to a future where no young person is left behind in the fight against HIV.
Incompleteness and misclassification of maternal deaths in Zimbabwe : data from two reproductive age mortality surveys, 2007-2008 and 2018-2019
(Springer, 2024-12) Musarandega, Reuben; Nystrom, Lennarth; Murewanhema, Grant; Gwanzura, Chipo; Ngwenya, Solwayo; Pattinson, Robert Clive; Machekano, Rhoderick; Munjanja, Stephen Peter; Zimbabwe Maternal and Perinatal Mortality Study Group
INTRODUCTION : We implemented two cross-sectional reproductive age mortality surveys in 2007–2008 and 2018–2019 to assess changes in the MMR and causes of death in Zimbabwe. We collected data from health institutions, civil registration and vital statistics, the community, and surveillance. This paper analyses missingness and misclassification of deaths in the two surveys. METHODS : We compared proportions of missed and misclassified deaths in the surveys using Chi-square or Fisher’s exact tests. Using log-linear regression models, we calculated and compared risk ratios of missed deaths in the data sources. We assessed the effect on MMRs of misclassifying deaths and analysed the sensitivity and specificity of identifying deaths in the surveys using the six-box method and risk ratios calculated through Binomial exact tests. RESULTS : All data sources missed and misclassified the deaths. The community survey was seven times [RR 7.1 (5.1–9.7)] and CRVS three times [RR 3.4 (2.4–4.7)] more likely to identify maternal deaths than health records in 2007–08. In 2018–19, CRVS [RR 0.8 (0.7–0.9)] and surveillance [RR 0.7 (0.6–0.9)] were less likely to identify maternal deaths than health records. Misclassification of causes of death significantly reduced MMRs in health records [RR 1.4 (1.2–1.5)]; CRVS [RR 1.3 (1.1– 1.5)] and the community survey/surveillance [RR 1.4 (1.2–1.6)]. CONCLUSION : Incompleteness and misclassification of maternal deaths are still high in Zimbabwe. Maternal mortality studies must triangulate data sources to improve the completeness of data while efforts to reduce misclassification of deaths continue.
Predictors of tuberculosis treatment outcome at Senkatana clinic in Lesotho
(African Field Epidemiology Network, 2024-11) Kabuya, Richard Mwamba; Musekiwa, Alfred; Takuva, Simbarashe G.; Thabane, Lehana; Mbuagbaw, Lawrence
INTRODUCTION: tuberculosis (TB) is one of the top ten causes of death and the leading cause from a single infectious agent called Mycobacterium tuberculosis. This study aims to evaluate TB treatment outcomes among patients on first-line anti-tuberculosis treatment and identify the factors associated with successful TB treatment outcomes at Senkatana TB clinic in Lesotho from 2015-2017. METHODS: a registry-based retrospective cohort study of all TB first-line cases recorded from 2015 to 2017 was conducted at Senkatana TB clinic. Data were captured and cleaned in Epi info version 7, and exported into Stata version 14 for analysis. Bivariate logistic regression analysis was used to determine factors associated with TB treatment outcome with p-value <0.05 indicating statistical significance. RESULTS: a total of 1,027 TB patients were registered between 2015 and 2017. Of these, 602 (58.6%) were males and 425 (41.4%) were females, with a mean age of 39 years (SD ±12.5). A total of 843 (82.1%) patients were co-infected with HIV, of which 92.3% (n=778) were on anti-retroviral therapy (ART). The analysis of HIV co-infected with TB patients by age showed that the TB/HIV coinfection rate varies with age (p<0.001). Overall treatment success rate was at 73.4% (n= 754) and 273 (26.6%) had poor treatment outcomes, and 118 (11.5%) patients died. The odds of successful TB treatment outcome were higher in females than males (78.1% vs 70.1%, OR 1.52, 95% CI: 1.14 - 2.03, p=0.004). With regards to age, the odds of successful TB treatment outcome were higher for the 20-24 years age group (88.2% vs 65.3%, OR 3.98, 95% CI: 1.42 - 11.22, P=0.009) and 55-59 years (91.7% vs 65.3%, OR 5.84, 95% CI: 1.56 - 21.88, P=0.009), compared to ≥ 65 years age group. In addition, successful TB treatment outcomes were higher among HIV co-infected TB patients who were taking ART during TB treatment than those not taking ART (75.8% vs 23.8%, OR 11.70, 95% CI: 6.40 - 21.43, P<0.001). Patients observed by family members or friends were more likely to develop treatment success (aOR: 1.87, 95% CI: 1.13 - 3.08). Factory workers in high-risk groups had successful treatment outcomes (aOR: 1.77, 95% CI: 1.04 - 3.01). CONCLUSION: tuberculosis treatment success rate was low and constant over the period of three years. Death rate, loss to follow, and not evaluated were high among our study participants and above the World Health Organization (WHO) target. In unadjusted analyses, female sex, younger age, HIV co-infected taking ART, having a treatment observer, and belonging to high-risk groups, were significantly associated with successful TB treatment outcome.
Awareness and openness to using PrEP among a nationally representative sample of South African adults
(African Field Epidemiology Network, 2024-07) Nkosi, Lungile; Mmem, Queen D.; Tsafa, Tina Ngufan; Ngodoo Gwar, Joy N.; Agaku, Israel Terungwa
INTRODUCTION: South Africa adopted for preexposure prophylaxis (PrEP) in 2016, becoming the first African country to do so. Yet to date, uptake has been underwhelming, only about 165,000 South Africans were reported to be on PrEP in mid2021. Lack of awareness has been cited as a contributory factor for the low uptake, but this has never been examined using a nationally representative sample. Methods: we investigated this among a national sample of HIV seronegative adults. Data were from the 2017/2018 South African National HIV Prevalence, Incidence, Behaviour and Communication Survey. Awareness and openness to using PrEP were self-reported. Weighted percentages were calculated overall and by demographic characteristics. RESULTS: overall, only 3.2% of seronegative adults spontaneously reported PrEP as a way of preventing HIV. Overall, 69.6% were open to using PrEP, from 58.2% in Western Cape, to 78.5% Northern Cape. Openness was highest among the youngest age group (18-29 years, 78.3%) and lowest among the oldest (60+ years, 45.6%). Striking racial differences were observed with openness among Black Africans (75.4%) being 2.5 times higher than Whites (29.0%). Among women, openness was 64.7% among those currently pregnant, 80.4% among those pregnant in the past two years but not now, and 67.8% among those who were not pregnant in the past two years (χ(2)=134.2, p<0.001). Among males, openness was higher among those circumcised (75.6%) than uncircumcised (64.5%). C0nclusion: planning for broad-scale implementation of PrEP within the South African context could build on knowledge gained from recent implementation and scale-up of relevant biomedical interventions (e.g. ART, voluntary medical male circumcision, and family planning).
The epidemiology of laboratory-confirmed Hepatitis B virus infection in the general population of South Africa, 2016- 2018
(African Field Epidemiology Network, 2024-08) Lamola, Mashudu Teresa; Musekiwa, Alfred; De Voux, Alex; Reddy, Carl; Mutevedzi, Portia Chipo
INTRODUCTION: despite the introduction of the Hepatitis B Virus (HBV) vaccine in South Africa in 1995, HBV remains endemic. South Africa's HBV vaccine coverage for the third dose was 71% in 2015. Information on the HBV prevalence in South Africa in recent years is limited, therefore, we estimated HBV prevalence and described annual trends. METHODS: we conducted a retrospective descriptive study of data extracted from the Notifiable Medical Conditions Surveillance System, and estimated HBV prevalence per 100,000 population using the mid-year population estimates obtained from Statistics South Africa, for the 2016-2018 period. RESULTS: in total, 105 308 laboratory-confirmed HBV cases were analysed, of which 50.2% (53 895/105 308), 95% CI (49.9-50.5) were males. HBV prevalence for males was 34.1 in 2016, 84.1 in 2017, and 72.3 per 100,000 population in 2018. The age group with the highest HBV cases and prevalence were ages 15-49 years having 80.5% (n=84 718), with 52.2 in 2016, 123.3 in 2017, and 99.6 per 100 000 population in 2018. Between 2016 and 2018, South Africa had an overall HBV prevalence of 33.8, 82.6, and 68.8 per 100,000 population, respectively. KwaZulu-Natal province had the highest number of HBV cases with 37.8% (n=39 851) however, Mpumalanga province had the highest HBV prevalence with 73.2 in 2016, 188.8 in 2017, and 126.5 per 100,000 population in 2018. CONCLUSION: our results indicated a high HBV prevalence is reflective of the group prior to the HBV vaccine introduction in South Africa.

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