scholarly journals Reduction in initiations of HIV treatment in South Africa during the COVID pandemic

2021 ◽  
Author(s):  
Mariet Benade ◽  
Lawrence Long ◽  
Sydney Rosen ◽  
Gesine Meyer-Rath ◽  
Jeanne-Marie Tucker ◽  
...  
Keyword(s):  
South Africa ◽  
Urban Areas ◽  
Hiv Transmission ◽  
Health Information System ◽  
Hiv Treatment ◽  
District Health ◽  
Data Set ◽  
Art Initiation ◽  
District Hospitals ◽  
Facility Level

Background: In response to the global pandemic of COVID-19, countries around the world began imposing stay-at-home orders, restrictions on transport, and closures of businesses in early 2020. South Africa implemented a strict lockdown in March 2020 before its first COVID-19 wave started, gradually lifted restrictions between May and September 2020, and then re-imposed restrictions in December 2020 in response to its second wave. There is concern that COVID-19-related morbidity and mortality, fear of transmission, and government responses may have led to a reduction in antiretroviral treatment (ART) initiations for HIV-infected individuals in countries like South Africa. Methods: We analyzed national, public sector, facility-level data from the South Africa District Health Information System (DHIS) from January 2019 to March 2021 to quantify changes in ART initiation rates stratified by province, setting, facility size and type and compared the timing of these changes to COVID-19 case numbers and government lockdown levels. We excluded facilities with missing data, mobile clinics, and correctional facilities. We estimated the total number of ART initiations per study month for each stratum and compared monthly totals, by year. Results: At the 2471 facilities in the final data set (59% of all ART sites in the DHIS), 28% fewer initiations occurred in 2020 than in 2019. Numbers of ART initiations declined sharply in all provinces in April-June 2020, compared to the same months in 2019, and remained low for the rest of 2020, with some recovery between COVID-19 waves in October 2020 and possible improvement beginning in March 2021. Percentage reductions were largest in district hospitals, larger facilities, and urban areas. After the initial decline in April-June 2020, most provinces experienced a clear inverse relationship between COVID-19 cases and ART initiations but little relationship between ART initiations and lockdown level. Conclusions: The COVID-19 pandemic and responses to it resulted in substantial declines in the number of HIV-infected individuals starting treatment in South Africa, with no recovery of numbers during 2020. These delays may lead to worse treatment outcomes for those with HIV and potentially higher HIV transmission. Exceptional effort will be needed to sustain gains in combating HIV.

scholarly journals Anemia among HIV-Infected Patients Initiating Antiretroviral Therapy in South Africa: Improvement in Hemoglobin regardless of Degree of Immunosuppression and the Initiating ART Regimen

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Simbarashe Takuva ◽  
Mhairi Maskew ◽  
Alana T. Brennan ◽  
Ian Sanne ◽  
A. Patrick MacPhail ◽  
...  
Keyword(s):  
South Africa ◽  
Hiv Treatment ◽  
Cd4 Count ◽  
Morbidity And Mortality ◽  
First Line ◽  
Art Initiation ◽  
Increased Risk ◽  
Prevalence Of Anemia

Among those with HIV, anemia is a strong risk factor for disease progression and death independent of CD4 count and viral load. Understanding the role of anemia in HIV treatment is critical to developing strategies to reduce morbidity and mortality. We conducted a prospective analysis among 10,259 HIV-infected adults initiating first-line ART between April 2004 and August 2009 in Johannesburg, South Africa. The prevalence of anemia at ART initiation was 25.8%. Mean hemoglobin increased independent of baseline CD4. Females, lower BMI, WHO stage III/IV, lower CD4 count, and zidovudine use were associated with increased risk of developing anemia during follow-up. After initiation of ART, hemoglobin improved, regardless of regimen type and the degree of immunosuppression. Between 0 and 6 months on ART, the magnitude of hemoglobin increase was linearly related to CD4 count. However, between 6 and 24 months on ART, hemoglobin levels showed a sustained overall increase, the magnitude of which was similar regardless of baseline CD4 level. This increase in hemoglobin was seen even among patients on zidovudine containing regimens. Since low hemoglobin is an established adverse prognostic marker, prompt identification of anemia may result in improved morbidity and mortality of patients initiating ART.

scholarly journals Towards an automated monitoring of human settlements in South Africa using high resolution SPOT satellite imagery

2015 ◽  
Vol XL-7/W3 ◽  
pp. 1389-1394 ◽  
Author(s):  
T. Kemper ◽  
N. Mudau ◽  
P. Mangara ◽  
M. Pesaresi
Keyword(s):  
South Africa ◽  
Satellite Imagery ◽  
Urban Areas ◽  
Informal Settlement ◽  
Informal Settlements ◽  
Image Features ◽  
Sub Saharan Africa ◽  
Image Feature ◽  
Data Set ◽  
Spot 5

Urban areas in sub-Saharan Africa are growing at an unprecedented pace. Much of this growth is taking place in informal settlements. In South Africa more than 10% of the population live in urban informal settlements. South Africa has established a National Informal Settlement Development Programme (NUSP) to respond to these challenges. This programme is designed to support the National Department of Human Settlement (NDHS) in its implementation of the Upgrading Informal Settlements Programme (UISP) with the objective of eventually upgrading all informal settlements in the country. Currently, the NDHS does not have access to an updated national dataset captured at the same scale using source data that can be used to understand the status of informal settlements in the country. <br><br> This pilot study is developing a fully automated workflow for the wall-to-wall processing of SPOT-5 satellite imagery of South Africa. The workflow includes an automatic image information extraction based on multiscale textural and morphological image features extraction. The advanced image feature compression and optimization together with innovative learning and classification techniques allow a processing of the SPOT-5 images using the Landsat-based National Land Cover (NLC) of South Africa from the year 2000 as low-resolution thematic reference layers as. The workflow was tested on 42 SPOT scenes based on a stratified sampling. The derived building information was validated against a visually interpreted building point data set and produced an accuracy of 97 per cent. Given this positive result, is planned to process the most recent wall-to-wall coverage as well as the archived imagery available since 2007 in the near future.

scholarly journals TB prevention cascade at a district hospital in rural Eastern Cape, South Africa

2021 ◽  
Vol 11 (2) ◽  
pp. 97-100
Author(s):  
B. J. van de Water ◽  
T. N. Meyer ◽  
M. Wilson ◽  
C. Young ◽  
B. Gaunt ◽  
...  
Keyword(s):  
South Africa ◽  
District Hospital ◽  
Close Contact ◽  
Primary Care Providers ◽  
Preventive Therapy ◽  
Eastern Cape ◽  
Care Providers ◽  
District Health ◽  
District Hospitals ◽  
Close Contacts

SETTING: Rural Eastern Cape, South Africa.OBJECTIVE: To identify steps in the TB preventive care cascade from routinely collected data among TB patients at a district hospital prior to the implementation of a novel TB program.DESIGN: This was a retrospective study. We adapted the TB prevention cascade to measure indicators routinely collected at district hospitals for TB using a cascade framework to evaluate outcomes in the cohort of close contacts.RESULTS: A total of 1,722 charts of TB patients were reviewed. The majority of patients (87%) were newly diagnosed with no previous episodes of TB. A total of 1,548 (90%) patients identified at least one close contact. A total of 7,548 contacts were identified with a median of 4.9 (range 1–16) contacts per patient. Among all contacts identified, 2,913 (39%) were screened for TB. Only 15 (0.5%) started TB preventive therapy and 122 (4.4%) started TB treatment. Nearly 25% of all medical history and clinical information was left unanswered among the 1,722 TB charts reviewed.CONCLUSION: Few close contacts were screened or started on TB preventive therapy in this cohort. Primary care providers for TB care in district health facilities should be informed of best practices for screening and treating TB infection and disease.

scholarly journals Low Disclosure Rates to Sexual Partners and Unsafe Sexual Practices of Youth Recently Diagnosed with HIV; Implications for HIV Prevention Interventions in South Africa

Healthcare ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 253 ◽  
Author(s):  
Khensane Mengwai ◽  
Sphiwe Madiba ◽  
Perpetua Modjadji
Keyword(s):  
South Africa ◽  
Antiretroviral Therapy ◽  
Partner Violence ◽  
Hiv Transmission ◽  
Sexual Partners ◽  
Hiv Treatment ◽  
Hiv Diagnosis ◽  
Cross Sectional Survey ◽  
Access To Treatment ◽  
Cross Sectional

The study investigated the motivation to disclose or the decision to withhold one’s HIV serostatus to one’s partners and assessed the implications of non-disclosure on young peoples’ sexual behaviour and access to treatment. This was a cross-sectional survey conducted with 253 youth aged 18–25 years receiving antiretroviral therapy in a health district in North West Province, South Africa. The majority were female (75%), the mean time since the HIV diagnosis was 22 months, 40% did not know their partner’s HIV status, 32% had more than two sexual partners, and 63% had not used a condom during the last sexual act. The prevalence of disclosure was 40%, 36% delayed disclosure for over a year, and most disclosed to protect the partner from HIV transmission, to receive support, and to be honest and truthful. The prevalence of non-disclosure was high, as 60% withheld disclosure due to fear of abandonment, stigma and discrimination, accusations of unfaithfulness, and partner violence. Over half (55%) had no intentions to disclose at all. The lower disclosure rates imply that HIV transmission continues to persist among sexual partners in these settings. The findings suggest that high levels of perceived stigma impact on disclosure and HIV treatment, which increases the risk of on-going HIV transmission among youth receiving long-term antiretroviral therapy (ART) in South Africa.

Costs of district hospitals in South Africa

2005 ◽  
Vol 16 (4) ◽  
pp. 431-440
Author(s):  
Abiodun Olukoga ◽  
Geoff Harris
Keyword(s):  
South Africa ◽  
Average Length ◽  
Unit Cost ◽  
Hospital Costs ◽  
Indirect Costs ◽  
Public Hospitals ◽  
Vulnerable Groups ◽  
District Health ◽  
Unit Costs ◽  
District Hospitals

The district hospitals are an integral part of the district health system (DHS) in South Africa fulfilling several important functions. Using data obtained from relevant published reports. The district hospital costs were allocated using the ‘ingredients approach’ that combined a top-down method and step-down sequence. The costs in the treatment of patients were grouped into six cost centres: buildings, drugs, equipment, materials, personnel and utilities. The unit costs were broadly grouped into two categories using the hospital departments (fixed and variable costs) and input use (direct and indirect costs). More than 30% of the total public expenditure on hospitals in the country was on district hospitals between 1996/97 and 1998/99. They had more beds per population (1.08/1000) than other public hospitals. The bed occupancy rates in these hospitals were generally very low varying between 57% and 75%. The average length of stay (ALOS) was within acceptable range in the hospital except in Osindisweni hospital. Personnel costs were more than 70% and drugs only 3% to 6% of the total costs. McCord hospital was the most expensive using total and unit costs. Harrismith hospital had the lowest total costs and Osindisweni hospital the lowest unit cost. Most of the costs were fixed or direct costs in all the hospitals. There is the need for the adoption of measures to ensure that the hospitals are efficiently run while maintaining access for vulnerable groups.

scholarly journals Perceived efficacy of HIV treatment-as-prevention among university students in Johannesburg, South Africa

2021 ◽  
pp. sextrans-2021-055031
Author(s):  
Jacob Bor ◽  
Nozipho Musakwa ◽  
Dorina Onoya ◽  
Denise Evans
Keyword(s):  
South Africa ◽  
University Students ◽  
Hiv Testing ◽  
Hiv Transmission ◽  
Hiv Treatment ◽  
Sub Saharan Africa ◽  
Transmission Risk ◽  
Treatment As Prevention ◽  
Relative Reduction ◽  
Objective Reduction

ObjectiveAntiretroviral therapy (ART) nearly eliminates HIV transmission. Yet information on treatment as prevention (TasP) has been slow to diffuse in sub-Saharan Africa. We assessed TasP knowledge among university students in South Africa.MethodsWe conducted a cross-sectional survey of first-year university students at a large public university in Johannesburg, South Africa, all of whom would have recently completed secondary school HIV curricula. Respondents were asked to consider the likelihood of HIV transmission in a serodiscordant couple having condomless sex with and without virally suppressive ART. Beliefs were elicited using a 0–20 visual scale. Perceived TasP efficacy was computed as the relative reduction in risk associated with virally suppressive ART. We compared beliefs with estimates from the scientific literature and assessed associations with demographics, HIV testing history and qualitative measures of HIV knowledge and risk perception.ResultsThe analysis included 365 university students ages 18-25 years (48% female, 56% from Gauteng Province). On average, perceived annual risk of HIV transmission with virally suppressive ART was 73%; the objective risk is <1%. On average, respondents perceived that virally suppressive ART reduced annual transmission risk by 17%; the objective reduction in risk is >96%. We observed no differences in perceived TasP efficacy by participant characteristics and testing history. Perceived TasP efficacy was correlated with the (correct) belief that HIV risk increases with sexual frequency.ConclusionsUniversity students in South Africa underestimated the prevention benefits of HIV treatment. Low knowledge of TasP could limit demand for HIV testing and treatment among young adults.

“I just found out that I have HIV”

HIV ◽  
2020 ◽  
pp. 9-20
Author(s):  
Ronald Lubelchek
Keyword(s):  
Hiv Transmission ◽  
Clinical Care ◽  
The United States ◽  
Hiv Treatment ◽  
People Living With Hiv ◽  
Art Initiation ◽  
Us Government ◽  
Control And Prevention ◽  
The Many ◽  
The Individual

Use of antiretroviral therapy (ART) to treat HIV leads to extensive benefits at both the individual and the public health levels. By gaining a more complete appreciation of the many benefits of ART, clinicians can make informed decisions regarding when to initiate ART for patients recently diagnosed with HIV. This chapter reviews both the immunologic and longevity gains attributable to ART, as well as ART’s effectiveness for preventing onward HIV transmission. Considering its effectiveness and due to improvements in ART’s potency, along with concomitant declines in ART-related adverse effects and pill burden, the pendulum of when to initiate ART has swung toward early imitation. Same day-of-diagnosis ART initiation, or rapid start within several days of diagnosis, has moved from the realm of research to clinical care. In the United States, the Centers for Disease Control and Prevention estimates that only 53% of people living with HIV have achieved virologic suppression. In recognition of the need to improve HIV-related outcomes, the US government has launched its Ending the HIV Epidemic (EtHE) initiative, which seeks a 90% reduction in the number of annual, new HIV diagnoses by 2030. HIV treatment, inclusive of the rapid start of ART, represents one of the EtHE initiative’s fundamental pillars. This chapter reviews the benefits of ART, highlights data supporting same-day/rapid ART imitation, and discusses its real-world application.

scholarly journals Technical efficiency and productivity of public district hospitals in KwaZulu-Natal province, South Africa

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Tesleem K. Babalola ◽  
Indres Moodley
Keyword(s):  
South Africa ◽  
Technical Efficiency ◽  
Significant Proportion ◽  
Health Service Delivery ◽  
Public Hospitals ◽  
District Health ◽  
District Hospitals ◽  
Study Results ◽  
Kwazulu Natal ◽  
Efficiency And Productivity

Background: District hospitals (DHs) constitute a significant proportion of public hospitals and consume a more substantial percentage of the government’s total hospital budget. With the level of resources disbursed to DHs, it is essential to ensure efficient allocation and utilization. Hence, this study set out to assess the technical efficiency and productivity of public DHs in KwaZulu-Natal province, South Africa. Methods: Data envelopment analysis (DEA) and Malmquist total factor productivity (MTFP) were used to assess technical efficiency, identify adjustments required to make inefficient facilities more efficient, and determine overall productivity growth. Input data such as medical personnel and output information such as outpatient visits were retrieved from the databases of the district health information system (DHIS), and personnel salary systems (PERSAL) for three consecutive financial years (2014/15, 2015/16 and 2016/17). A total of 38 district hospitals were included in the study. Results: The proportion of technically efficient facilities according to constant return to scale (CRS) were 12 (31.6%), 16 (42.1%) and 14 (36.8%) in 2014/15, 2015/16 and 2016/17, respectively, while according to the variable return to scale (VRS) technically efficient facilities were 22 (57.9%), 19 (50.0) and 21 (55.2%), respectively, for the three consecutive years. On average, the total productivity of DHs increased by 4.8 percent over the three years, which is attributed majorly to technical growth of 6.9 percent. Conclusion: This study showed that a significant proportion of the district hospitals were technically inefficiency. Also, steps that could enable more efficient use of healthcare resources to yield optimal health service delivery were recommended.

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