The global tuberculosis burden remains substantial, with more than 10 million people newly ill per year. Nevertheless, tuberculosis incidence has slowly declined over the past decade, and mortality ...has decreased by almost a third in tandem. This positive trend was abruptly reversed by the COVID-19 pandemic, which in many parts of the world has resulted in a substantial reduction in tuberculosis testing and case notifications, with an associated increase in mortality, taking global tuberculosis control back by roughly 10 years. Here, we consider points of intersection between the tuberculosis and COVID-19 pandemics, identifying wide-ranging approaches that could be taken to reverse the devastating effects of COVID-19 on tuberculosis control. We review the impact of COVID-19 at the population level on tuberculosis case detection, morbidity and mortality, and the patient-level impact, including susceptibility to disease, clinical presentation, diagnosis, management, and prognosis. We propose strategies to reverse or mitigate the deleterious effects of COVID-19 and restore tuberculosis services. Finally, we highlight research priorities and major challenges and controversies that need to be addressed to restore and advance the global response to tuberculosis.
Drug-resistant tuberculosis (DR-TB) epidemic is driven mainly by the effect of ongoing transmission. In high-burden settings such as South Africa (SA), considerable demographic and geographic ...heterogeneity in DR-TB transmission exists. Thus, a better understanding of risk-factors for clustering can help to prioritise resources to specifically targeted high-risk groups as well as areas that contribute disproportionately to transmission.
The study analyzed potential risk-factors for recent transmission in SA, using data collected from a sentinel molecular surveillance of DR-TB, by comparing demographic, clinical and epidemiologic characteristics with clustering and cluster sizes. A genotypic cluster was defined as two or more patients having identical patterns by the two genotyping methods used. Clustering was used as a proxy for recent transmission. Descriptive statistics and multinomial logistic regression were used.
The study identified 277 clusters, with cluster size ranging between 2 and 259 cases. The majority (81.6%) of the clusters were small (2-5 cases) with few large (11-25 cases) and very large (≥ 26 cases) clusters identified mainly in Western Cape (WC), Eastern Cape (EC) and Mpumalanga (MP). In a multivariable model, patients in clusters including 11-25 and ≥ 26 individuals were more likely to be infected by Beijing family, have XDR-TB, living in Nelson Mandela Metro in EC or Umgungunglovo in Kwa-Zulu Natal (KZN) provinces, and having history of imprisonment. Individuals belonging in a small genotypic cluster were more likely to infected with Rifampicin resistant TB (RR-TB) and more likely to reside in Frances Baard in Northern Cape (NC).
Sociodemographic, clinical and bacterial risk-factors influenced rate of Mycobacterium tuberculosis (M. tuberculosis) genotypic clustering. Hence, high-risk groups and hotspot areas for clustering in EC, WC, KZN and MP should be prioritized for targeted intervention to prevent ongoing DR-TB transmission.
Outcomes of HIV-infected children have improved dramatically over the past decade, but are undermined by patient loss to follow-up (LTFU). We assessed patterns of LTFU among HIV-infected children ...receiving antiretroviral treatment (ART) at a large inner-city HIV clinic in Johannesburg, South Africa between 2005 and 2014.Demographic and clinical data were extracted from clinic records of children under 12 years. Differences between characteristics of children retained in care and LTFU were assessed using Wilcoxon rank sum tests or Pearson χ tests. Cox proportional hazard models then identified characteristics associated with LTFU.Of 135 children, the median age at ART initiation was 21.5 months (IQR: 6.3-47.7) with a median follow-up time of 3.3 years (IQR: 1.4-5.0). The incidence rate of LTFU was 10.8 per 100 person-years (95% CI: 8.2-14.4); cumulatively 36% of children were LTFU. Almost a third (n = 39) of children missed a clinic visit, but then returned to care; 77% of these were eventually LTFU. In total, 18% of children had elevated viral loads after 6 or more months of ART. Older age at ART initiation (18-59 months: aHR 1.6, 95% CI: 3.9-14.2) and ever missing a clinic visit (aHR 7.4 95% CI: 3.9-14.2) were independent predictors of LTFU.High rates of LTFU were observed in this primary care clinic. Risks for LTFU included older age (>18 months old) and missed clinic visits. Identifying children who miss scheduled visits and developing strategies directed at retaining them in care is critical to improving long-term pediatric HIV outcomes.
Cement workers are exposed to various kinds of occupational hazards, dust being the most hazardous. Despite certain exposure limits on the emission of air pollutants in place, several people die each ...year due to complications from respiratory disease. This study aimed to assess the prevalence of chronic respiratory symptoms among workers exposed to cement dust. A quantitative, descriptive cross-sectional design was employed among 81 workers from two cement production companies in Gauteng, South Africa in 2018. A self-administered questionnaire, anthropometric measurements, and a spirometry test were used as data collection tools. Data were analyzed using Wilcoxon rank sum, binary logistic regression, Pearson's chi-squared, and Fischer's exact tests. Respiratory symptoms such as wheezing, recurring blocked nose, sneezing/stuffy nose, fatigue/tiredness, rapid breathing, soreness/watery eyes, and breathlessness were significantly prevalent among participants from both facilities. Engineering and housekeeping control measures such as the use of High-Efficiency Particulate Air (HEPA) vacuums to clean up dust and proper use of Personal Protective Equipment (PPE) where workers are exposed to dust particles should be implemented.
ObjectiveTo assess whether decentralising colposcopy services to a primary care facility in inner-city Johannesburg, South Africa raises access to colposcopy.DesignBefore–after study comparing 2 ...years before and 2 years after decentralisation, using clinical records and laboratory data on cervical cytology and histology.Primary outcomeThe proportion of all women attending Hillbrow Community Health Centre (HCHC) with an abnormal Papanikolaou (Pap) smear who had a colposcopy post-decentralisation.SettingCharlotte Maxeke Johannesburg Academic Hospital (CMJAH) has provided colposcopy services for several decades. HCHC, located about 3 km away, began colposcopy services in 2014.ParticipantsWomen, aged above 18 years, who had a colposcopy for diagnosis and treatment of precancerous cervical lesions following a Pap smear, from 2012 to 2016 at CMJAH or HCHC.ResultsPre-decentralisation at CMJAH, 910 women had colposcopy (2012–2014). Post-decentralisation (2014–2016), 721 had colposcopy at CMJAH and 399 at HCHC, the decentralised facility. The number who had a Pap smear at HCHC and then a colposcopy rose threefold post-decentralisation (114 vs 350). Post-decentralisation, 43 women at HCHC were referred to CMJAH for colposcopy, compared with 114 pre-decentralisation. Post-decentralisation, 47.3% of women at CMJAH waited >6 months for colposcopy, while 35.5% did at HCHC (p<0.001). Across all three groups, 26.9%–30.3% of women had cervical intraepithelial neoplasia III lesions or carcinoma on colposcopy. The proportion of invalid specimens was similar at CMJAH and HCHC (1.8%–2.8%). Of 401 women who had an abnormal Pap smear at HCHC post-decentralisation, 267 had colposcopy (66.6%).ConclusionDecentralisation can decrease the time to colposcopy and reduce the workload of tertiary hospitals. Overall, more women accessed services. Colposcopy coverage at HCHC is higher than other sites, but could be further improved. Decentralisation did not appear to undermine the quality of services and this model could be extended to similar settings in South Africa and elsewhere.
Cement workers are exposed to various kinds of occupational hazards, dust being the most hazardous. Despite certain exposure limits on the emission of air pollutants in place, several people die each ...year due to complications from respiratory disease. This study aimed to assess the prevalence of chronic respiratory symptoms among workers exposed to cement dust. A quantitative, descriptive cross-sectional design was employed among 81 workers from two cement production companies in Gauteng, South Africa in 2018. A self-administered questionnaire, anthropometric measurements, and a spirometry test were used as data collection tools. Data were analyzed using Wilcoxon rank sum, binary logistic regression, Pearson's chi-squared, and Fischer's exact tests. Respiratory symptoms such as wheezing, recurring blocked nose, sneezing/stuffy nose, fatigue/tiredness, rapid breathing, soreness/watery eyes, and breathlessness were significantly prevalent among participants from both facilities. Engineering and housekeeping control measures such as the use of High-Efficiency Particulate Air (HEPA) vacuums to clean up dust and proper use of Personal Protective Equipment (PPE) where workers are exposed to dust particles should be implemented.
Master of Science in Epidemiology in the field of Epidemiology and Biostatistics;
June, 2017
Background;
Hepatitis B and ART have been established to cause liver damage. We compared the changes in ...the levels of Alanine amino Transferase (ALT) in HBV/HIV co-infected and HIV infected women on ART to determine liver disease among women on ART in Lilongwe Malawi using Data from the BAN study.;
Methods;
We conducted a secondary data analysis from The BAN study to investigate the changes in the levels of ALT among HIV/HBV co-infected and HIV mono-infected women who were randomised into the maternal ART arm. In brief The BAN study assessed the benefit of nutritional supplementation given to women during breastfeeding, the benefit and safety of antiretroviral medications given either to infants or to their mothers to prevent HIV transmission during breastfeeding and the feasibility of exclusive breastfeeding followed by early, rapid breastfeeding cessation. ALT was monitored up to 48 weeks with an average of 12 follow-ups per individual. Continuous variables i.e. Age, ALT and CD4 count were compared between HIV/HBV co-infected women and HIV mono-infected women using the Wilcoxon rank sum test. Multiple regression analyses were performed using longitudinal data Generalised Linear mixed models to evaluate the relationship between ALT and HIV/HBV co-infection, among HIV-infected women, controlling for ART regimen, CD4 count and visit. All individuals were included in the analysis regardless of the different numbers of follow-up visits. To show the change of ALT levels longitudinal line graphs were used. Predictions of ALT levels per visit were also plotted using margin plots.;
Results;
The study subjects comprised of 544 women of whom 5.6% were HIV/HBV co-infected. The age range of the study population was 16-45 years. Median age at enrolment was 26(IQR: 22-29). The median ALT enzyme level of HIV/HBV co-infected individuals was slightly higher at baseline (13 UI/L (10-16) vs 14 UI/L (11-18, p=0.10) and at the last follow-up (17UI/L (14-22) vs 19 UI/L (16-26, p=0.04) compared to HIV mono-infected counterparts. HIV/HBV co-infection women were 3.28 times (1.43-9.03 p= 0.01) more likely to have abnormal ALT, compared to their mono-HIV infected counterparts. Individuals that were initiated on Nelfinavar as first line ART were 3.22;
times (1.85-5.59 p=0.001) more likely to have elevated ALT compared to those that were initiated on LPV/r based regimen. Moderately immune suppressed women (CD4 count of between 200 to 500 cells/dl) were 0.38 times less likely to have elevated ALT(0.15-1.00) while women who were severely immune suppressed had 3.51 times more likely to have abnormal ALT . Overall there was an increase in the level of ALT per each subsequent visit.;
Conclusion;
Individuals co-infected with HIV/HBV generally had higher levels of ALT compared to HIV mono-Infected individuals and this increased over time. The current study suggests that monitoring of ALT in patients co-infected with HIV/ HBV on ART should be performed regularly, and the caution should be taken when prescribing first line ART.
MT2017
Black young adults have disproportionately high rates of HIV and sexually transmitted infections (STIs) when compared with the national average. Although parent-child sexual health communication ...among Black families has been shown to reduce sexual risk-taking behaviors, far less is known about father-daughter sexual health communication when compared with communication among gender-congruent dyads and mothers. This dearth of knowledge hinders the development of sexual health interventions involving fathers that are sensitive to both the gendered and cultural context. Using constructivist-grounded theory, the present study explores the context surrounding sexual health communication between Black women aged 19-21 (M = 20.3) years and their biological fathers aged 52-60 (M = 56.7) years. Seven father-daughter (N = 7) dyads and an additional five (N = 5) daughters completed individual in-depth semistructured interviews lasting on average 84 min in length. Analysis revealed several social, cultural, and familial contexts impacting father-daughter communication, in addition to factors that either motivate or hinder communication. Daughters who did not engage in sexual health communication with their fathers expressed an interest in doing so, and participants highlighted varying behavioral, emotional, and relational outcomes resulting from father-daughter sexual health communication or the lack thereof. Study findings can inform future intervention development and strengthen the positive role fathers play in ensuring daughters' healthy sexual development.
Abstract Introduction Parent–child sexual health communication reduces sexual risk behaviors among youth, which in turn lowers the transmission rate of HIV and sexually transmitted infections. ...Despite being a known protective factor, gender differences persist with mothers being more likely to discuss sexual health with their children than fathers. Although individual characteristics, interpersonal familial factors and societal norms (e.g., communication self‐efficacy, parent–child closeness, and cultural and gender norms) are associated with Black parents' likelihood to communicate about sex with their children, the current study seeks to explore which of these factors found among Black mother–child or father–son dyads extend to Black father–daughter dyads and how this phenomenon (i.e., Black father–daughter sexual health communication) relates to family structure. Methods Seven father–daughter dyads ( N = 7) and an additional five daughters ( n = 5) in the United States completed individual in‐depth semi‐structured interviews. Daughters ( M age = 20.3) and fathers ( M age = 56.7) were biologically related, majority heterosexual, close, and lived together. Data were transcribed verbatim and analyzed using thematic analysis. Results Analysis revealed three themes centering around the role of authoritative parenting, the tactics and skills facilitating sexual health communication, and family structure. Conclusions Black father–daughter sexual health communication is facilitated by close father–daughter relationships, non‐authoritative parenting styles, and open, supportive, and non‐judgmental communication. Fathers can be better supported in knowing how and when best to communicate sexual health messages, and to mitigate the possibly negative impacts on communication of divorce or having multiple children.
Abstract
Youths experiencing homelessness (YEH) become pregnant at five times the general population rate. Education, social, and health care systems struggle to adequately address this young ...community’s sexual and reproductive health needs, yet social workers are well positioned across sectors to address their sexual and reproductive health and well-being. A growing body of literature exists on the factors affecting YEH’s access and selection of birth control, prompting the present review that aimed to understand this process and inform better attuned sexual and reproductive health approaches. Using a systematic search and analytic approach, we retrieved 203 articles, of which 23 met inclusion criteria. Key findings emerged across socioecological levels, including barriers and facilitators to condom use; the differential impact on YEH of hormonal birth control side effects; and the devastating effects of economic insecurity leading to sexual exploitation, survival sex, and exposure to violence. Implications include the need for multilevel intervention that addresses youths’ knowledge, attitudes, and behavior as well the need to improve social norms and system design to provide better attuned care for YEH.
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