Potential Clinical and Economic Value of Long-Acting Preexposure Prophylaxis for South African Women at High-Risk for HIV Infection

Abstract Background A number of studies have shown central adiposity, in particular visceral adipose tissue (VAT) accumulation to be a hallmark of metabolic syndrome (MetS). In clinical practice, waist circumference (WC) is used as a proxy for VAT. Aim To compare the ability of dual energy x-ray absorptiometry (DXA)-derived VAT area and anthropometric measures of adiposity for diagnosing MetS in a sample of high risk South African women. Methods MetS was quantified using the Joint Interim Statement (JIS) criteria. Fasting glucose, insulin and lipid profile were measured in 204 post-menopausal women. Anthropometry measures included body mass index (BMI), WC, waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and a body shape index (ABSI). The area under the curve (AUC) was used to assess their performance in detecting any two components of MetS (excluding WC). Optimal WC and VAT area cut-points were derived to compare their performance for diagnosing MetS and to compare to internationally recognised cut-points. Results The highest AUC for the prediction of MetS was recorded for VAT, followed by WHtR and WC (AUC, 0.767, 0.747 and 0.738 respectively), but these did not differ significantly (all p ≥ 0.192). In contrast, VAT was significantly better than BMI (p = 0.028), hip (p = 0.0004) and ABSI (p < 0.0001). The optimal WC (94.4 cm) and VAT area (174 cm2 based on the Youden’s index method and 175.50 cm2 based on the CTL approach) cut-points performed similarly in detecting MetS. Conclusion DXA-derived VAT and WC had the same overall performance in discriminating the presence of any 2 MetS components in high risk South African women. These findings support the current recommendations of using WC rather than VAT for MetS risk screening, as it is cheap, accessible and easy to measure.

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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

Health SA Gesondheid ◽

10.4102/hsag.v21i0.949 ◽

2016 ◽

Vol 21 ◽

pp. 171-178 ◽

Cited By ~ 6

Author(s):

Firoza Haffejee ◽

Katie A. Ports ◽

Maghboeba Mosavel

Keyword(s):

South Africa ◽

Health Care ◽

Hiv Infection ◽

South African ◽

Low Income ◽

African Women ◽

Hiv Education ◽

Testing Procedures ◽

South African Women ◽

Hiv Aids

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 toc hild transmission (PMTCT) amongst South African women from a low income community. It also established the challenges in delivering HIV education from the perspectives of health care volunteers.Method: Female residents (n = 67) from Kenneth Gardens, a low income community in Durban, South Africa were interviewed. In-depth semi-structured interviews were conducted with 12 health care volunteers who were either health care workers or residents who provided some form of social support in the community.Results: The majority of respondents indicated that a mother 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 education 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.

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