scholarly journals Optimised paediatric antiretroviral treatment to achieve the 95-95-95 goals

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Mohandran Archary ◽  
Riana Van Zyl ◽  
Nosisa Sipambo ◽  
Gillian Sorour
Keyword(s):  
South Africa ◽  
Young Children ◽  
Antiretroviral Treatment ◽  
Paediatric Population ◽  
African Countries ◽  
Treatment Failure Rate ◽  
Life Saving ◽  
Sub Saharan ◽  
Speak Up ◽  
Living With Hiv

While the progress towards reaching the UNAIDS 95-95-95 targets in South African adults seems promising, the progress in the paediatric population is lagging far behind; only 79% percent of children living with HIV know their status. Of these, only 47% are on treatment, and a mere 34% of those are virally suppressed. Thus, virological suppression has been attained in only 13% of children living with HIV in South Africa. Multiple factors contribute to the high treatment failure rate, one of them being a lack of paediatric-friendly antiretroviral treatment (ART) formulations. For example, the Lopinavir/ritonavir syrup, which is the current mainstay of ART for young children, has an extremely unpleasant taste, contributing to the poor tolerability and lack of adherence by children using the formulation. Furthermore, the lack of appropriate formulations limits the optimisation of regimens, especially for young children and those who cannot swallow tablets. Switching from syrups to dispersible tablets will improve ease of administration and adherence and result in cost-saving. Despite the approval of simplified paediatric-friendly formulations internationally, including other sub-Saharan African countries, unnecessary delays are experienced in South Africa. Clinician groups and community organisations must speak up and demand that approvals be expedited to ensure the delivery of life-changing and life-saving formulations to our patients as a matter of urgency.

scholarly journals Relationships with caregivers and mental health outcomes among adolescents living with HIV: a prospective cohort study in South Africa

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yulia Shenderovich ◽  
Mark Boyes ◽  
Michelle Degli Esposti ◽  
Marisa Casale ◽  
Elona Toska ◽  
...  
Keyword(s):  
Mental Health ◽  
South Africa ◽  
Cohort Study ◽  
Mental Health Problems ◽  
Health Problems ◽  
Sub Saharan Africa ◽  
Depression Symptoms ◽  
Sub Saharan ◽  
Positive Caregiving ◽  
Living With Hiv

Abstract Background Mental health problems may impact adherence to anti-retroviral treatment, retention in care, and consequently the survival of adolescents living with HIV. The adolescent-caregiver relationship is an important potential source of resilience. However, there is a lack of longitudinal research in sub-Saharan Africa on which aspects of adolescent-caregiver relationships can promote mental health among adolescents living with HIV. We draw on a prospective longitudinal cohort study undertaken in South Africa to address this question. Methods The study traced adolescents aged 10–19 initiated on antiretroviral treatment in government health facilities (n = 53) within a health district of the Eastern Cape province. The adolescents completed standardised questionnaires during three data collection waves between 2014 and 2018. We used within-between multilevel regressions to examine the links between three aspects of adolescent-caregiver relationships (caregiver supervision, positive caregiving, and adolescent-caregiver communication) and adolescent mental health (depression symptoms and anxiety symptoms), controlling for potential confounders (age, sex, rural/urban residence, mode of infection, household resources), n=926 adolescents. Results Improvements in caregiver supervision were associated with reductions in anxiety (0.98, 95% CI 0.97–0.99, p=0.0002) but not depression symptoms (0.99, 95% CI 0.98–1.00, p=.151), while changes in positive caregiving were not associated with changes in mental health symptoms reported by adolescents. Improvements in adolescent-caregiver communication over time were associated with reductions in both depression (IRR=0.94, 95% CI 0.92–0.97, p<.0001) and anxiety (0.91, 95% CI 0.89–0.94, p<.0001) symptoms reported by adolescents. Conclusions Findings highlight open and supportive adolescent-caregiver communication and good caregiver supervision as potential factors for guarding against mental health problems among adolescents living with HIV in South Africa. Several evidence-informed parenting programmes aim to improve adolescent-caregiver communication and caregiver supervision, and their effect on depression and anxiety among adolescents living with HIV should be rigorously tested in sub-Saharan Africa. How to improve communication in other settings, such as schools and clinics, and provide communication support for caregivers, adolescents, and service providers through these existing services should also be considered.

Motivating people living with HIV to initiate antiretroviral treatment outside national guidelines in three clinics in the HPTN 071 (PopART) trial, South Africa

2021 ◽  
Vol 20 (1) ◽  
pp. 32-41
Author(s):  
Constance Mubekapi-Musadaidzwa ◽  
Dillon Wademan ◽  
Neshaan Peton ◽  
Portia Hendricks ◽  
Gabriela Carolus ◽  
...  
Keyword(s):  
South Africa ◽  
Antiretroviral Treatment ◽  
People Living With Hiv ◽  
National Guidelines ◽  
Living With Hiv

HIV/AIDS

2020 ◽  
pp. 901-933
Author(s):  
Sarah Fidler ◽  
Timothy E.A. Peto ◽  
Philip Goulder ◽  
Christopher P. Conlon
Keyword(s):  
Large Scale ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
African Countries ◽  
Global Pandemic ◽  
The People ◽  
Reduce Life Expectancy ◽  
Sub Saharan ◽  
Living With Hiv ◽  
The Impact

Since its discovery in 1983, the human immunodeficiency virus (HIV) has been associated with a global pandemic that has affected more than 78 million people and caused more than 39 million deaths. Globally, 36.9 million (34.3–41.4 million) people were living with HIV at the end of 2013. An estimated 0.8% of adults aged 15–49 years worldwide are living with HIV, although the burden of the epidemic continues to vary considerably between countries and regions. Sub-Saharan Africa remains most severely affected, with nearly 1 in every 20 adults living with HIV and accounting for nearly 71% of the people living with HIV worldwide. The impact of HIV in some African countries has been sufficient to reverse population growth and reduce life expectancy into the mid-30s, although HIV incidence has declined in some of these high-prevalence countries. However, there are large-scale HIV epidemics elsewhere (e.g. India, the Russian Federation, and Eastern Europe).

scholarly journals How to understand, evaluate and influence efficient progress in South Africa’s land reform process: A typology from historical lessons from selected sub-Saharan African countries

2017 ◽  
Vol 20 (1) ◽  
Author(s):  
Nhlanhla C. Mbatha
Keyword(s):  
South Africa ◽  
Land Reform ◽  
Historical Review ◽  
Social Institutions ◽  
Reform Process ◽  
Policy Uncertainty ◽  
African Countries ◽  
Post Colonial ◽  
Black Farmers ◽  
Sub Saharan

Background: With reports of widespread failures in South Africa’s land reform programmes, the levels of policy uncertainty in the political rhetoric that influences land reform have been increasing. Since 1994 policy targets to transfer land to black farmers have not been met. Of the 2005 target to transfer about 25 million ha of commercial farmland to black farmers by 2014, less than 5 million ha. have been transferred for commercial use. Some studies report failure rates in resettlement projects of up to 90%. To account for the failures, revisions of policies and amendments to legislations have been proposed within a political environment that is becoming increasingly intolerant to slow progress in land transfers and to resettlement failures.Aim: Against this environment, this paper presents a typology for understanding and evaluating important elements of the land reform project in order to influence progress in the process.Setting: The study adopts a historical review of land reform processes in post-colonial Kenya and Zimbabwe in order to identify potential challenges and key lessons for South Africa.Methods: Hence, using institutional and historical analytical lenses in exploring different narratives, the paper reviews reported failures and successes in land reform policy cases from the selected countries. From an institutional framework, prevalent social institutions and key lessons from Kenya, Zimbabwe and South Africa, a typology for evaluating important elements of the land reform process in South Africa is developed and discussed. Additionally, a review of global data collected on average sizes of farms in different regions of the world is provided as evidence to support propositions of what would constitute efficient farmland size ranges for small to medium commercial farms in South Africa.Results and conclusion: A proposition is made on how to use the typology to guide policy and research interventions to reduce failures and promote successful cases in different areas of the land reform process in South Africa, and possibly other similar contexts.

scholarly journals South-South migration and elections: evidence from post-apartheid South Africa

2020 ◽  
Vol 11 (1) ◽  
Author(s):  
Biniam E. Bedasso ◽  
Pascal Jaupart
Keyword(s):  
South Africa ◽  
Ethnic Diversity ◽  
Negative Impact ◽  
African National Congress ◽  
Sub Saharan Africa ◽  
African Countries ◽  
Single Issue ◽  
Local Public Services ◽  
Sub Saharan ◽  
Election Results

AbstractLittle is known about the political consequences of immigration in Sub-Saharan Africa. In this paper, we estimate the effect of exposure to immigration on election outcomes in South Africa. Our analysis is based on municipality panel data and an instrumental variable (IV) strategy exploiting historical migrant settlement patterns. We find that local immigration concentration has a negative impact on the performance of the incumbent African National Congress, whereas support for the main opposition party, the Democratic Alliance, is found to increase in municipalities with a larger immigrant presence. These effects hold regardless of the skill levels of immigrants in a municipality. In terms of mechanisms, competition over jobs and local public services as well as ethnic diversity and cultural factors influence how immigration affects election outcomes. These findings are robust to a broad range of sensitivity checks. They provide evidence that immigration can be a politically salient issue in migrant-destination Sub-Saharan African countries. They also show that immigration can affect election results even in contexts where there is no single issue anti-migrant party.

scholarly journals OPPORTUNISTIC INFECTIONS DIAGNOSED IN PATIENTS INFECTED WITH THE HUMAN IMMUNODEFICIENCY VIRUS (HIV) AT THE SERVICE OF INFECTIOUS DISEASES OF UHC (UNIVERSITY HOSPITAL CENTER) YALGADO OUÉDRAOGO, BURKINA FASO

2021 ◽  
pp. 1-2
Author(s):  
Savadogo M ◽  
Diallo I ◽  
Sondo K A
Keyword(s):  
Infectious Diseases ◽  
Hiv Infection ◽  
Opportunistic Infection ◽  
Antiretroviral Treatment ◽  
Opportunistic Infections ◽  
Sub Saharan Africa ◽  
University Hospital ◽  
Cross Sectional ◽  
Sub Saharan ◽  
Living With Hiv

Introduction: Sub-Saharan Africa remains one of the regions most affected by HIV infection with severe lethality.Most deaths of patients living with HIV are caused by opportunistic infections. Objective: to determine the prevalence of opportunistic infections among patients living with HIV in hospital serving infectious diseases of UHC YO of Ouagadougou. Patients and Methods:This is a cross-sectional descriptive study covering a 14-month period from 1 January 2017 to 28 February 2018. Included were all HIV-positive patients, hospitalized at the service of Infectious Diseases, in which an opportunistic infection was diagnosed on the basis of clinical and/or para-clinical arguments. Results: During the study period a total of 55 patients living with HIV were hospitalized in the infectious disease unit,35 of whom had at least one opportunistic infection or 63.6% of the patients.The average age of patients was 37 years with extremes of 18 and 66 years.Twenty-two patients were female versus 13 male, a sex ratio = 0.59. HIV1 was involved in 97% of patients.The mean TCD4 lymphocyte rate was 156 cell/mm3 with extremes of 7 and 718 cell/mm3.Tuberculosis and digestive mycosis were the most frequently diagnosed opportunistic infections. Opportunistic infection was the circumstance for HIV testing in two patients.She revealed immune restoration syndrome in two other patients.Nineteen patients were already on antiretroviral treatment upon admission to the service.Half of the patients on treatment were in therapeutic failure.The evolution was marked by 26.5% lethality. Conclusion:The frequency of opportunistic infections is high in patients living with HIV.Their prevention requires early detection of HIV infection and antiretroviral treatment.

scholarly journals Angola - an Oil Dependant Country in Sub-Saharan Africa

2016 ◽  
Vol 9 (35) ◽  
pp. 233-242
Author(s):  
Boris Baumgartner
Keyword(s):  
South Africa ◽  
World Economy ◽  
Sub Saharan Africa ◽  
African Countries ◽  
The Third ◽  
The World ◽  
Sub Saharan ◽  
The One ◽  
Rich Countries ◽  
Essential Problem

Abstract The Sub-Saharan Africa belongs to the most underdeveloped regions in the world economy. This region consists of forty nine countries but it’s world GDP share is only a small percentage. There are some very resource rich countries in this region. One of them is Angola. This former Portuguese colony has one of the largest inventories of oil among all African countries. Angola recorded one of the highest growth of GDP between 2004-2008 from all countries in the world economy and nowadays is the third biggest economy in Sub-Saharan Africa after Nigeria and South Africa. The essential problem of Angola is the one-way oriented economy on oil and general on natural resources. Angola will be forced to change their one-way oriented economy to be more diversified and competitive in the future.

scholarly journals Accuracy of self-reported HIV testing history and awareness of HIV-positive status among people living with HIV in four Sub-Saharan African countries

AIDS ◽  
2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Yiqing Xia ◽  
Rachael M. Milwid ◽  
Arnaud Godin ◽  
Marie-Claude Boily ◽  
Leigh F. Johnson ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Hiv Positive ◽  
People Living With Hiv ◽  
African Countries ◽  
Sub Saharan ◽  
Living With Hiv

African states hope the Gulf crisis will end soon

2017 ◽  
Keyword(s):  
South Africa ◽  
Saudi Arabia ◽  
Sub Saharan Africa ◽  
African Union ◽  
African Countries ◽  
Content Type ◽  
Gulf Countries ◽  
Political Effects ◽  
Gulf Crisis ◽  
Sub Saharan

Significance The split between Qatar and its neighbours has pushed a few small African countries to side with Saudi Arabia, but leaves the continent’s leading powers and several conflict-afflicted nations eager to stay neutral -- for now. In sub-Saharan Africa (SSA) -- where Gulf countries have strong diplomatic ties and major economic investments -- the crisis has had significant political effects. Impacts The withdrawal of Qatari peacekeepers from the Djibouti-Eritrea border will become a pressing concern for the African Union. Ongoing expulsions of African migrants from Saudi Arabia will complicate Saudi and Emirati efforts to find African partners against Qatar. Countries such as South Africa and Nigeria may begin to act more assertively in calling for neutrality.

scholarly journals Copula geoadditive modelling of anaemia and malaria in young children in Kenya, Malawi, Tanzania and Uganda

2020 ◽  
Vol 39 (1) ◽  
Author(s):  
Danielle J. Roberts ◽  
Temesgen Zewotir
Keyword(s):  
Young Children ◽  
Joint Probability ◽  
Positive Association ◽  
Spatial Effects ◽  
African Countries ◽  
Dependency Structure ◽  
Explanatory Variables ◽  
Childhood Morbidity ◽  
Sub Saharan ◽  
The Relationship

Abstract Background Anaemia and malaria are the leading causes of sub-Saharan African childhood morbidity and mortality. This study aimed to explore the complex relationship between anaemia and malaria in young children across the districts or counties of four contiguous sub-Saharan African countries, namely Kenya, Malawi, Tanzania and Uganda, while accounting for the effects of socio-economic, demographic and environmental factors. Geospatial maps were constructed to visualise the relationship between the two responses across the districts of the countries. Methods A joint bivariate copula regression model was used, which estimates the correlation between the two responses conditional on the linear, non-linear and spatial effects of the explanatory variables considered. The copula framework allows the dependency structure between the responses to be isolated from their marginal distributions. The association between the two responses was set to vary according to the district of residence across the four countries. Results The study revealed a positive association between anaemia and malaria throughout the districts, the strength of which varied across the districts of the four countries. Due to this heterogeneous association between anaemia and malaria, we further considered the joint probability of each combination of outcome of anaemia and malaria to further reveal more about the relationship between the responses. A considerable number of districts had a high joint probability of a child being anaemic but not having malaria. This might suggest the existence of other significant drivers of childhood anaemia in these districts. Conclusions This study presents an alternative technique to joint modelling of anaemia and malaria in young children which assists in understanding more about their relationship compared to techniques of multivariate modelling. The approach used in this study can aid in visualising the relationship through mapping of their correlation and joint probabilities. These maps produced can then help policy makers target the correct set of interventions, or prevent the use of incorrect interventions, particularly for childhood anaemia, the causes of which are multiple and complex.

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