1.  Title: Skillz [magazine], 4 Soccer 4 Life. Football for an HIV-Free Generation. Edition 1: Join the team. Author: Football for an HIV Free Generation Source: Skillz. 2009;:[8] p. Abstract: Skillz magazine features international soccer stars as well as young Africans who are making a difference in their communities and leading the fight against HIV and AIDS. Language: English Keywords: SOUTH AFRICA | SUMMARY REPORT | YOUTH | HIV PREVENTION | SPORTS | COMMUNICATION STRATEGY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Age Factors | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Social Behavior | Behavior | Communication Document Number: 331379 |
| 2. Title: Helping mothers keep their babies safe from HIV. Author: Population Council Source: Momentum. 2009 Jun;:[1] p. Abstract: The Population Council's evaluation of m2m provided solid evidence that the program was helping women use services to prevent transmission of HIV to their children. An innovative program, mothers2mothers (m2m), was created in South Africa to support HIV-positive pregnant women. The program trains and employs HIV-positive mothers who have used services to prevent mother-to-child transmission of HIV. These "mentor mothers" organize health talks and conduct regular support groups for their peers. They also reach out to the community to help women follow feeding practices that are best for their baby. They promote safer sex and family planning, and encourage mothers to return for HIV treatment and to bring their baby to the clinic for HIV testing. Women who participated in m2m were more likely to talk about their HIV status with friends and family members, to receive drugs to reduce the chance that their baby would be infected with HIV, and to follow recommended infant feeding practices. Following the evaluation, the program has expanded to hundreds of other locations in South Africa and beyond to Lesotho, Zambia, Kenya, Rwanda, Malawi, and Swaziland -- providing hope and care to HIV-positive mothers across Africa. Language: English Keywords: SOUTH AFRICA | SUMMARY REPORT | WOMEN | PERSONS LIVING WITH HIV/AIDS | INFANT NUTRITION | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | PARTICIPATION | STIGMA | SOCIAL DISCRIMINATION | UTILIZATION OF HEALTH CARE | COUNSELING | TREATMENT | NEEDS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Nutrition | Health | Disease Transmission Control | Prevention and Control | Social Behavior | Behavior | Social Problems | Sociocultural Factors | Health Services | Delivery of Health Care | Clinic Activities | Program Activities | Programs | Organization and Administration | Medical Procedures | Medicine | Economic Factors Document Number: 331490 |
| 3. Title: Increasing HIV testing for at-risk children. Author: Population Council Source: Momentum. 2009 Jun;:[1] p. Abstract: The Caregiver Project is helping HIV-positive children access life-saving medical treatment and providing an outreach model that can be replicated across Africa. The project trains grandmothers (called “grannies") to serve as peer supporters for elderly caregivers. The grannies provide information about pediatric HIV testing and treatment to elderly caregivers who come to Social Security Agency sites to get grants for social services for children and the elderly. Grannies offer caregivers referral cards that list the locations of pediatric testing services and encourage them to take the children to be tested. The Caregiver Project is targeting an important gateway to accessing these children, the elderly caregivers, and motivating caregivers to seek care through age-appropriate resources. (Excerpts) Language: English Keywords: SOUTH AFRICA | SUMMARY REPORT | ORPHANS AND VULNERABLE CHILDREN | PERSONS LIVING WITH HIV/AIDS | CARE AND SUPPORT | PROMOTION | HIV TESTING | TREATMENT | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Family and Household | Sociocultural Factors | HIV Infections | Viral Diseases | Diseases | Health Services | Delivery of Health Care | Health | Marketing | Economic Factors | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine Document Number: 331491 |
| 4. Title: Advice columns in South African print publications. Author: Soul City Institute for Health and Development Communication Source: [Houghton, South Africa], Soul City Institute for Health and Development Communication, [2009]. 17 p. Abstract: This paper reports on a study about letters to and responses from advice columnists in 13 South African publications over a three-month period. Approximately 40 percent of letters to the columnists asked for advice about multiple concurrent partnerships, but less than half of the answers included information related to HIV and the increased risk of infection that accompanies such relationships. Instead, the columnists chose to focus on emotional or moral issues of concurrent partnerships. The paper highlights this missed opportunity to address HIV-prevention issues. Language: English Keywords: SOUTH AFRICA | SUMMARY REPORT | RESPONDENTS | PRINTED MEDIA | HIV INFECTIONS | AIDS | KNOWLEDGE | COUNSELING | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Surveys | Sampling Studies | Studies | Research Methodology | Mass Media | Communication | Viral Diseases | Diseases | Sociocultural Factors | Clinic Activities | Program Activities | Programs | Organization and Administration Document Number: 331820 |
5.  Peer Reviewed Title: HIV infection and tuberculosis in South Africa: an urgent need to escalate the public health response. Author: Abdool Karim SS; Churchyard GJ; Abdool Karim Q; Lawn SD Source: Lancet. 2009 Sep 12;374(9693):921-33. Abstract: One of the greatest challenges facing post-apartheid South Africa is the control of the concomitant HIV and tuberculosis epidemics. HIV continues to spread relentlessly, and tuberculosis has been declared a national emergency. In 2007, South Africa, with 0.7% of the world's population, had 17% of the global burden of HIV infection, and one of the world's worst tuberculosis epidemics, compounded by rising drug resistance and HIV co-infection. Until recently, the South African Government's response to these diseases has been marked by denial, lack of political will, and poor implementation of policies and programmes. Nonetheless, there have been notable achievements in disease management, including substantial improvements in access to condoms, expansion of tuberculosis control efforts, and scale-up of free antiretroviral therapy (ART). Care for acutely ill AIDS patients and long-term provision of ART are two issues that dominate medical practice and the health-care system. Decisive action is needed to implement evidence-based priorities for the control of the HIV and tuberculosis epidemics. By use of the framework of the Strategic Plans for South Africa for tuberculosis and HIV/AIDS, we provide prioritised four-step approaches for tuberculosis control, HIV prevention, and HIV treatment. Strong leadership, political will, social mobilisation, adequate human and financial resources, and sustainable development of health-care services are needed for successful implementation of these approaches. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | CLIENTS | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | TUBERCULOSIS | ANTIRETROVIRAL THERAPY | DRUG RESISTANCE | HEALTH SERVICES | DELIVERY OF HEALTH CARE | MANAGEMENT | TREATMENT | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Program Activities | Programs | Organization and Administration | Viral Diseases | Diseases | Infections | HIV | Medical Procedures | Medicine | Health Document Number: 342870 |
| 6. Title: Prevention of invasive pneumococcal disease in HIV-infected children: expanding the toolbox [editorial] Author: Abzug MJ; Pelton SI Source: Journal of Infectious Diseases. 2009 Apr 15;199(8):1109-11. Abstract: Invasive pneumococcal disease (IPD) remains a threat to HIV-infected children, adolescents, and adults in both developed and emerging nations. In the pre-highly active antiretroviral therapy (HAART) era, Mao et al. identified a cumulative incidence of 6.1 cases per 100 patient-years through age 7 years among HIV-infected children in Massachusetts, a rate 100-300-fold that seen in HIV-uninfected immunocompetent children in the United States. Similarly, Westwood et al. reported an IPD rate of 13 cases per 100 patient-years in Capetown, South Africa, a large proportion of which were lower respiratory tract infections. With widespread use of HAART in the United States, the rate of pneumococcal bacteremia declined by 80%, to 1.9 cases per 100 patient-years; this residual rate still remained at least 10-fold greater than that among HIV-uninfected children, and children who suffered an episode of pneumococcal bacteremia were more likely to die during follow-up than were HIV-infected children without an episode. These data identify the need to protect HIV-infected children from infection with Streptococcus pneumoniae, even in populations treated with HAART. (excerpt) Language: English Keywords: UNITED STATES OF AMERICA | MASSACHUSETTS | SOUTH AFRICA | SUMMARY REPORT | CLINICAL TRIALS | PERSONS LIVING WITH HIV/AIDS | CHILDREN | ADULTS | ADOLESCENTS | ANTIRETROVIRAL THERAPY | DISEASE PREVENTION | VACCINES | Developed Countries | North America | Americas | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Clinical Research | Research Methodology | HIV Infections | Viral Diseases | Diseases | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | HIV | Prevention and Control | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 341354 |
| 7. Peer Reviewed Title: Unmet need for contraception among HIV-positive women in Lesotho and implications for mother-to-child transmission. Author: Adair T Source: Journal of Biosocial Science. 2009 Mar;41(2):269-78. Abstract: In Lesotho, the risk of mother-to-child-transmission (MTCT) of HIV is substantial; women of childbearing age have a high HIV prevalence rate (26.4%), low knowledge of HIV status and a total fertility rate of 3.5 births per woman. An effective means of preventing MTCT is to reduce unwanted fertility. This paper examines the unmet need for contraception to limit and space births among HIV-positive women in Lesotho aged 15-49 years, using the 2004 Lesotho Demographic and Health Survey. HIV-positive women have their need for contraception unmet in almost one-third of cases, and multivariate analysis reveals this unmet need is most likely amongst the poor and amongst those not approving of family planning. Urgent action is needed to lower the level of unmet need and reduce MTCT. A constructive strategy is to improve access to family planning for all women in Lesotho, irrespective of HIV status, and, more specifically, integrate family planning with MTCT prevention and voluntary counselling and testing services. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | KAP SURVEYS | DEMOGRAPHIC AND HEALTH SURVEYS | MULTIVARIATE ANALYSIS | URBAN POPULATION | WOMEN IN DEVELOPMENT | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | KNOWLEDGE | CONTRACEPTION | NEEDS ASSESSMENT | BIRTH SPACING | POVERTY | ATTITUDES | PROGRAM ACCESSIBILITY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Surveys | Sampling Studies | Studies | Research Methodology | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Data Analysis | Population Characteristics | Economic Development | Economic Factors | Disease Transmission Control | Prevention and Control | Diseases | Sociocultural Factors | Family Planning | Evaluation | Socioeconomic Factors | Psychological Factors | Behavior | Program Evaluation | Programs | Organization and Administration Document Number: 331114 |
| 8. Peer Reviewed Title: Sexual risk behaviour of the first cohort undergoing screening for enrollment into Phase I/II HIV vaccine trials in South Africa. Author: Andersson KM; Van Niekerk RM; Niccolai LM; Mlungwana ON; Holdsworth IM; Bogoshi M; McIntyre JA; Gray GE; Vardas E Source: International Journal of STD and AIDS. 2009 Feb;20(2):95-101. Abstract: We assessed risk behaviour in a heterosexual cohort undergoing prescreening for the first Phase I/II HIV vaccine trials in Soweto. We developed a survey and collected self-reported data from HIV-negative potential volunteers. Of 488 participants, most were single and approximately half were from households with incomes below the poverty level. Males reported higher rates of heavy alcohol use (P < 0.001), marijuana use (P < 0.001) and other recreational drug use (P < 0.01). Males reported more sex partners than females in the previous six months (P < 0.001), as well as more casual/anonymous partners (P < 0.001) and one-night stands (P < 0.001). Multivariate analyses revealed substance use and male gender predicted higher risk behaviours, including <100% condom use with known/suspected HIV-positive partners, having casual/anonymous partners and having more than two partners. For this population, male volunteers may need increased risk-reduction counselling during Phase I/II trials and additional recruitment methods may be necessary to identify high-risk female volunteers for Phase III efficacy trials. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | KAP SURVEYS | CLINICAL TRIALS | MULTIVARIATE ANALYSIS | HETEROSEXUALS | SEXUAL PARTNERS | SEX BEHAVIOR | RISK BEHAVIOR | VACCINES | ALCOHOL USE AND ABUSE | SCREENING | POVERTY | DRUG USE AND ABUSE | SEX FACTORS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Surveys | Sampling Studies | Studies | Research Methodology | Clinical Research | Data Analysis | Behavior | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Examinations and Diagnoses | Socioeconomic Factors | Economic Factors | Population Characteristics | Demographic Factors | Population Document Number: 331093 |
| 9. Peer Reviewed Title: HIV testing rates and outcomes in a South African community, 2001-2006: implications for expanded screening policies. Author: April MD; Walensky RP; Chang Y; Pitt J; Freedberg KA; Losina E; Paltiel AD; Wood R Source: Journal of Acquired Immune Deficiency Syndromes. 2009 Jul 1;51(3):310-6. Abstract: BACKGROUND: Revised World Health Organization recommendations seek to increase HIV testing. We assessed the need for expanded testing in South Africa by examining current testing and treatment trends among a high prevalence population. METHODS: We determined the numbers of adults receiving HIV testing and antiretroviral treatment (ART) during 2001-2006 using testing registers linked to patient records from 2 health care facilities believed responsible for virtually all HIV services available to the population. We evaluated annual population testing rates using census population counts; proportions of clients testing seropositive (yield); CD4 counts and World Health Organization stage at diagnosis; and ART initiation rates. RESULTS: HIV testing rates rose from 4% in 2001 to 20% in 2006 (P < 0.001) and were highest among pregnant females receiving provider-initiated testing. Yield for first-time testers decreased from 47% in 2001 to 28% in 2006; annual incidence of seroconversion among initially HIV-negative retesters was 1.9%. Median CD4 counts and World Health Organization stage distributions for newly diagnosed clients remained stable. HIV-infected clients receiving ART within 6 months of eligibility increased from 0% in 2001 to 68% in 2006 (P < 0.001). CONCLUSIONS: Population testing and ART initiation rates rose dramatically during 2001-2006. Yet, yield remained high, and HIV-infected persons continued to receive late diagnoses. These findings highlight the continuing need for expanded testing and linkage to care. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | DATA LINKAGE | STATISTICAL STUDIES | HIV TESTING | ANTIRETROVIRAL THERAPY | VOLUNTARY COUNSELING AND TESTING | SCREENING | HEALTH POLICY | CENSUS | HIV INFECTIONS | PREVALENCE | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Data Collection | Research Methodology | Studies | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV | Viral Diseases | Diseases | Policy | Political Factors | Sociocultural Factors | Population Statistics | Measurement Document Number: 342149 |
| 10. Title: PRISM tools for assessing, monitoring, and evaluating RHIS performance. Author: Aqil A; Lippeveld T Source: Chapel Hill, North Carolina, University of North Carolina at Chapel Hill, Carolina Population Center [CPC], MEASURE Evaluation, 2009 Mar. [32] p. (MS-09-34USAID Cooperative Agreement No. GPO-A-00-03-00003-00) Abstract: PRISM Framework and its tools applications have expanded since 2004. Now it has been applied in Pakistan, Uganda, South Africa, Mexico, Paraguay, Honduras, Haiti, China and Cote d'Ivore for assessment and evaluation. It has been applied in diverse countries of Africa, Asia, Latin America and Carribean continents. While these applications showed the strengths and appropriateness of PRISM Framework and its tools in identifying strengths and weaknesses of the routine information systems, they brought some challenges to attention. First, to make a distinction between RHIS performance indicators -accuracy, timeliness and completeness, from their counterpart processes. Second, to keep minimum variables in various tools for triangulation of information to avoid respondent's burden of filling the details. Third, better measurement of use of information. Thus, there was a need to revise the PRISM tools. Uganda PRISM evaluation in 2007 for testing its reliability and validity also helped to make the revisions. PRISM tools version 3.0 meets old and new challenges in assessing, monitoring and evaluation of RHIS. Language: English Keywords: PAKISTAN | MEXICO | HONDURAS | HAITI | CHINA | PARAGUAY | SOUTH AFRICA | UGANDA | SUMMARY REPORT | EVALUATION | INFORMATION PROCESSING | DATA COLLECTION | MANAGEMENT | PROGRAM ACTIVITIES | Developing Countries | Asia, Southern | Asia | North America | Americas | Central America | Latin America | Caribbean | Asia, Eastern | South America, Central | South America | Africa, Southern | Africa, Sub Saharan | Africa | Africa, Eastern | Information | Research Methodology | Organization and Administration | Programs Document Number: 339994 |
| 11. Title: Philani program: a case study of an integrative approach of empowerment and social and economic development. Author: Austin SA; Mbewu N Source: Social Work In Public Health. 2009 Jan-Apr;24(1-2):148-60. Abstract: This article reports a case study of a South African nongovernmental organization's role in implementing maternal and child health care services for families in Khayelitsha, an informal township in the Western Cape. The township is an extremely poor community with high unemployment and many other social indicators of high need. The case study explores how services were enhanced to respond to the service needs of children and families. The role of economic development as a means of empowering the mothers is examined within the context of nongovernmental organization services. The implications of developing services that integrate social and economic development are discussed as a model for social work practice in the United States. Language: English Keywords: SOUTH AFRICA | SUMMARY REPORT | CASE STUDIES | NONGOVERNMENTAL ORGANIZATIONS | MATERNAL-CHILD HEALTH SERVICES | NEEDS | POVERTY | ECONOMIC DEVELOPMENT | SOCIAL DEVELOPMENT | WOMEN'S EMPOWERMENT | INTEGRATED PROGRAMS | SOCIAL POLICY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Organizations | Political Factors | Sociocultural Factors | Primary Health Care | Health Services | Delivery of Health Care | Health | Economic Factors | Socioeconomic Factors | Women's Status | Programs | Organization and Administration | Policy Document Number: 341952 |
| 12. Peer Reviewed Title: Effect of male circumcision on the prevalence of high-risk human papillomavirus in young men: results of a randomized controlled trial conducted in orange farm, South Africa. Author: Auvert B; Sobngwi-Tambekou J; Cutler E; Nieuwoudt M; Lissouba P; Puren A; Taljaard D Source: Journal of Infectious Diseases. 2009 Jan 1;199(1):14-9. Abstract: The authors used data from a male circumcision (MC) trial conducted in Orange Farm, South Africa among men aged 18-24 years to investigate the association between male circumcision (MC) and the prevalence of high-risk human papillomavirus (HR-HPV) among young men. Urethral swab samples were collected during a period of 262 consecutive days from participants in the intervention (circumcised) and control (uncircumcised) groups who were reporting for a scheduled follow-up visit. Swab samples were analyzed using polymerase chain reaction. HR-HPV prevalence rate ratios were assessed using univariate and multivariate log Poisson regression. In an intention-to-treat analysis, the prevalence of HR-HPV among the intervention group was 14.8% (94/637) and in the control group was 22.3% (140/627). Controlling for propensity score and confounders (ethnic group, age, education, sexual behavior [including condom use], marital status, and human immunodeficiency virus status) had no effect on the results. This is the first randomized controlled trial to show a reduction in the prevalence of urethral HR-HPV infection after MC. This finding explains why women with circumcised partners are at a lower risk of cervical cancer than other women. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | CLINICAL TRIALS | EPIDEMIOLOGIC METHODS | YOUTH | MULTIVARIATE ANALYSIS | MEN | MALE CIRCUMCISION | HPV | PREVALENCE | RISK FACTORS | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Clinical Research | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Data Analysis | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Viral Diseases | Diseases | Measurement | Biology Document Number: 328586 |
| 13. Peer Reviewed Title: Neonatal near miss: a measure of the quality of obstetric care. Author: Avenant T Source: Best Practice and Research. Clinical Obstetrics and Gynaecology. 2009 Jun;23(3):369-374. Abstract: Thirty-seven percent of under-five deaths occur in the neonatal period. Identifying and correcting factors that contribute to neonatal and maternal care are of the utmost importance. Evaluation of severe acute maternal morbidity, also known as “near miss”, is used to improve obstetric practice. Neonatal near miss in conjunction with neonatal mortality can be used in a similar fashion to identify deficiencies in care. No accepted definition of neonatal near miss currently exists. None of the neonatal morbidity scoring systems is applicable or appropriate for this purpose. Organ system based criteria are objective and allow for identifying severe morbidities and identifying primary causes. This system can be of use in a variety of settings to identify health system problems and to institute remedial action where necessary. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | PREGNANCY | MATERNAL MORTALITY | PERINATAL MORTALITY | MORBIDITY | QUALITY OF HEALTH CARE | MATERNAL-CHILD HEALTH SERVICES | MEASUREMENT | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Reproduction | Mortality | Population Dynamics | Demographic Factors | Population | Diseases | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Primary Health Care | Health Services | Delivery of Health Care | Health | Research Methodology Document Number: 341303 |
| 14. Title: Minimally invasive surgery for children with HIV/AIDS. Author: Banieghbal B Source: Journal of Laparoendoscopic and Advanced Surgical Techniques. Part A. 2009 Feb;19(1):97-101. Abstract: AIM: Human deficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS) have resulted in millions of deaths in Sub-Saharan Africa from opportunist infections. Children are not spared and are similarly affected. Minimally invasive surgery (MIS) can be used, in a selected number of children, as a mean to establish diagnosis or render a treatment. MATERIALS AND METHODS: This study was comprised of a 7-year retrospective analysis of a single pediatric surgeon's experience in South Africa. Forty-eight children, with ages 3 months to 14 years, with HIV/AIDS underwent laparoscopic/thoracoscopic exploration and treatment. RESULTS: Diagnostic laparoscopy and biopsy were the most common procedures (29 cases) indicated for nonspecific abdominal pain or rectal bleeding. The second most common procedure was laparoscopic antireflux fundoplication (10 cases) for damaged lower esophageal sphincter secondary to chronic candidal infection. The remaining procedures were for other rare surgical conditions, seen often in AIDS patients. No significant procedure-related complications occurred, but there were 2 mortalities from the underlying pathology in this cohort. CONCLUSIONS: This is the largest report on MIS for children with HIV/AIDS in the medical literature. It is shown that laparoscopic/thoracoscopic exploration and treatment in children with HIV/AIDS is safe and indicated for establishing the diagnosis and treatment of these unfortunate children. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | CLINICAL RESEARCH | LONGITUDINAL STUDIES | ORPHANS AND VULNERABLE CHILDREN | PERSONS LIVING WITH HIV/AIDS | SURGERY | LAPAROSCOPY | PHYSICAL EXAMINATIONS AND DIAGNOSES | PAIN | BLEEDING | CANDIDIASIS | GASTROINTESTINAL EFFECTS | COMPLICATIONS | AIDS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Studies | Family and Household | Sociocultural Factors | HIV Infections | Viral Diseases | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Endoscopy | Examinations and Diagnoses | Signs and Symptoms | Bacterial and Fungal Diseases | Infections | Physiology | Biology Document Number: 330998 |
| 15. Peer Reviewed Title: Lack of a decline in HIV incidence in a rural community with high HIV prevalence in South Africa, 2003-2007. Author: Barnighausen T; Tanser F; Newell ML Source: AIDS Research and Human Retroviruses. 2009 Apr;25(4):405-9. Abstract: To understand the dynamics of the HIV epidemic and to plan HIV treatment and prevention programs, it is critical to know how HIV incidence in a population evolves over time. We used data from a large population-based longitudinal HIV surveillance in a rural community in South Africa to test whether HIV incidence in this population has changed in the period from 2003 through 2007. We observed 563 seroconversions in 8095 individuals over 16,256 person-years at risk, yielding an overall HIV incidence of 3.4 per 100 person-years (95% confidence interval 3.1-3.7). We included time-dependent period dummy variables (in half-yearly increments) in age-stratified Cox regressions in order to test for trends in HIV incidence. We first did regression analyses separately for women and men. In both regressions, the coefficients of all period dummy variables were individually insignificant (all p > or = 0.338) and jointly insignificant (p = 0.764 and p = 0.111, respectively). We then did regression analysis using the pooled data on women and men, controlling for sex and interactions between sex and age. Again, the coefficients of the eight period dummy variables were individually insignificant (all p > or = 0.387) and jointly insignificant (p = 0.701). We show for the first time that high levels of HIV incidence have been maintained without any sign of decline over the past 5 years in both women and men in a rural South African community with high HIV prevalence. It is unlikely that the HIV epidemic in rural South Africa can be reversed without new or intensified efforts to prevent HIV infection. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | INCIDENCE | PREVALENCE | RURAL POPULATION | HIV INFECTIONS | HIV PREVENTION | PROGRAM EVALUATION | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Measurement | Research Methodology | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Programs | Organization and Administration Document Number: 341543 |
| 16. Peer Reviewed Title: Loss to care and death before antiretroviral therapy in Durban, South Africa. Author: Bassett IV; Wang B; Chetty S; Mazibuko M; Bearnot B; Giddy J; Lu Z; Losina E; Walensky RP; Freedberg KA Source: Journal of Acquired Immune Deficiency Syndromes. 2009 Jun 1;51(2):135-9. Abstract: OBJECTIVE: To examine the loss to care and mortality rates before starting antiretroviral therapy (ART) among ART eligible HIV-infected patients in Durban, South Africa. Design: Retrospective cohort study. METHODS: We reviewed data from ART eligible adults (> or = 18 years) at an urban HIV clinic that charges a monthly fee from July to December 2006. ART eligibility was based on CD4 count < or = 200 cells per microliter or clinical criteria and a psychosocial assessment. Patients who did not start ART and were lost within 3 months were phoned. Correlates of loss to care were evaluated using logistic regression. RESULTS: During the study period, 501 patients registered for ART training. Mean time from initial CD4 count to first ART training was 3.6 months (interquartile range 2.3-3.9 months). Four hundred eight patients (81.4%) were in care and on ART at 3-month follow-up, and 11 (2.2%) were in care but had not initiated ART. Eighty-two ART eligible patients (16.4%) were lost before ART initiation. Of these, 28 (34.1%) had died; two thirds of deaths occurred before or within 2 months after the first ART training. Despite multiple attempts, 32 patients (39%) were unreachable by phone. Lower baseline CD4 counts (< or = 100 cells/microL) and unemployment were independently associated with being lost. CONCLUSIONS: Loss to care and death occur frequently before starting ART at an HIV clinic in Durban, South Africa. This delay from CD4 count to ART training, even among those with the lowest CD4 counts, highlights the need for interventions that improve linkage to care and prioritize ART initiation for those with low baseline CD4 counts. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | RETROSPECTIVE STUDIES | CLIENTS | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | CARE AND SUPPORT | PROGRAM ACCESSIBILITY | TIME FACTORS | MORTALITY | EMPLOYMENT STATUS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | HIV | Health Services | Delivery of Health Care | Health | Program Evaluation | Population Dynamics | Demographic Factors | Population | Socioeconomic Status | Socioeconomic Factors | Economic Factors Document Number: 341755 |
| 17. Peer Reviewed Title: The management of failed second-trimester termination of pregnancy. Author: Basu JK; Basu D Source: Contraception. 2009 Aug;80(2):170-3. Abstract: BACKGROUND: Management of failed medical second-trimester termination of pregnancy (TOP) is a challenge with best therapy not determined. STUDY DESIGN: This was a cross-sectional study using retrospective record review of all women requesting medical TOP in the second trimester from January to June 2005. A comparative analysis was done to determine differences in demography, surgical methods and complications between two groups: (a) women who successfully aborted (first-admission group) and (b) women who failed to abort during their first admission (repeat-admission group). RESULTS: Study sample included 567 subjects [523 (92%) in the first-admission group and 44 (8%) in the repeat-admission group]. There were no significant differences in gestational age (p=.99), parity (p=.24) and previous history of cesarean section (p=.38) between the two groups. All of them successfully aborted, but the women in the repeat-admission Group 4 (9%) had more surgical interventions than those in the first-admission Group 6 (2%) (p<.0001). CONCLUSION: Failure to abort pregnancies in the second trimester with misoprostol is not uncommon. Our hospital protocol of adequate counseling and early repeat admission with good clinical selection criteria might be an alternative in a resource-constraint environment where resources and skills to perform surgical dilatation and evacuation are not available. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | RETROSPECTIVE STUDIES | COMPARATIVE STUDIES | ABORTION | MISOPROSTOL | PREGNANCY, SECOND TRIMESTER | CERVICAL DILATATION | CURETTAGE | HYSTEROTOMY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Fertility Control, Postconception | Family Planning | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Pregnancy | Reproduction | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Obstetrical Surgery | Surgery | Gynecologic Surgery | Urogenital Surgery Document Number: 342391 Notification |
| 18. Peer Reviewed Title: Bone mineral density in a cohort of adolescents during use of norethisterone enanthate, depot-medroxyprogesterone acetate or combined oral contraceptives and after discontinuation of norethisterone enanthate. Author: Beksinska ME; Kleinschmidt I; Smit JA; Farley TM Source: Contraception. 2009 May;79(5):345-9. Abstract: BACKGROUND: Depot medroxyprogesterone acetate (DMPA), norethisterone enanthate (NET-EN) and combined oral contraceptives (COCs) have been shown to have a negative effect on bone mineral density (BMD) in adolescents. The aim of this study was to investigate BMD in 15- to 19-year-old new users of DMPA, NET-EN and COCs. STUDY DESIGN: This 5-year longitudinal study followed up new users of DMPA (n=115), NET-EN (n=115) and COCs (n=116) and 144 nonuser controls. BMD was measured at the distal radius using dual-energy X-ray absorptiometry. RESULTS: BMD increased in all groups (annual percent increase: nonusers, 1.49%; DMPA, 1.39%; NET-EN, 1.03%; COCs, 0.84%) during follow-up (p<.001). There was evidence for lower BMD increases per annum in NET-EN (p=.050) and COC (p=.010) users compared to nonusers but no difference between DMPA and nonusers (p=.76). In 14 NET-EN discontinuers, an overall reduction of 0.61% per year BMD was followed upon cessation by an increase of 0.69% per year (p=.066). CONCLUSION: This study suggests that BMD increases in adolescents may be less in NET-EN and COC users; however, recovery of BMD in NET-EN users was found in the small sample of adolescents followed post-discontinuation. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | CLINICAL RESEARCH | COHORT ANALYSIS | COMPARATIVE STUDIES | ADOLESCENTS, FEMALE | WOMEN IN DEVELOPMENT | SKELETAL EFFECTS | CONTRACEPTION TERMINATION | NORETHINDRONE ENANTHATE | DEPO-PROVERA | ORAL CONTRACEPTIVES, COMBINED | ORAL CONTRACEPTIVES, SIDE EFFECTS | CONTRACEPTIVE SAFETY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Studies | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Physiology | Biology | Contraception | Family Planning | Norethindrone | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Medroxyprogesterone Acetate | Oral Contraceptives | Contraceptive Methods | Safety | Public Health | Health Document Number: 330938 |
| 19. Peer Reviewed Title: Bone mineral density in young women aged 19-24 after 4-5 years of exclusive and mixed use of hormonal contraception. Author: Beksinska ME; Kleinschmidt I; Smit JA; Farley TM; Rees HV Source: Contraception. 2009 Aug;80(2):128-32. Abstract: BACKGROUND: Use of depot-medroxyprogesterone acetate (DMPA), norethisterone enanthate (NET-EN) and low-dose combined oral contraceptives (COCs) has been associated with loss of bone mineral density (BMD) in adolescents. However, the effect of using a combination of these methods over time in this age group is limited. The aim of this cross-sectional study was to investigate BMD in young women (aged 19-24 years) with a history of mixed hormonal contraceptive use. STUDY DESIGN: BMD was measured at the spine, hip and femoral neck using dual X-ray absorptiometry. Women were classified into three groups: (1) injectable users (DMPA, NET-EN or both) (n=40), (2) mixed COC and injectable users (n=13) and (3) non-user control (n=41). RESULTS: Women in the injectables-only user group were found to have lower BMDs compared to the non-user group at all three sites, and there was evidence of a difference in BMD between these two groups at the spine after adjusting for body mass index (p=.042), hip (p=.025) and femoral neck (p=.023). The mixed COC/injectable user group BMD values were lower than those for controls; however, there was no evidence of a significant difference between this group and the non-user group at any of the three sites. CONCLUSION: This study suggests that BMD is lower in long-term injectable users but not when women have mixed injectable and COC use. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | CONTROL GROUPS | WOMEN | YOUTH | INJECTABLES | DEPO-PROVERA | ORAL CONTRACEPTIVES, COMBINED | CONTRACEPTIVE AGENTS, SIDE EFFECTS | SKELETAL EFFECTS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Demographic Factors | Population | Age Factors | Population Characteristics | Contraceptive Methods | Contraception | Family Planning | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Oral Contraceptives | Physiology | Biology Document Number: 342307 |
| 20. Peer Reviewed Title: Expanding antiretroviral options in resource-limited settings--a cost-effectiveness analysis. Author: Bendavid E; Wood R; Katzenstein DA; Bayoumi AM; Owens DK Source: Journal of Acquired Immune Deficiency Syndromes. 2009 Sep 1;52(1):106-13. Abstract: BACKGROUND: Current World Health Organization (WHO) guidelines for treatment of HIV in resource-limited settings call for 2 antiretroviral regimens. The effectiveness and cost-effectiveness of increasing the number of antiretroviral regimens is unknown. METHODS: Using a simulation model, we compared the survival and costs of current WHO regimens with two 3-regimen strategies: an initial regimen of 3 nucleoside reverse transcriptase inhibitors followed by the WHO regimens and the WHO regimens followed by a regimen with a second-generation boosted protease inhibitor (2bPI). We evaluated monitoring with CD4 counts only and with both CD4 counts and viral load. We used cost and effectiveness data from Cape Town and tested all assumptions in sensitivity analyses. RESULTS: Over the lifetime of the cohort, 25.6% of individuals failed both WHO regimens by virologic criteria. However, when patients were monitored using CD4 counts alone, only 6.5% were prescribed additional highly active antiretroviral therapy due to missed and delayed detection of failure. The life expectancy gain for individuals who took a 2bPI was 6.7-8.9 months, depending on the monitoring strategy. When CD4 alone was available, adding a regimen with a 2bPI was associated with an incremental cost-effectiveness ratio of $2581 per year of life gained, and when viral load was available, the ratio was $6519 per year of life gained. Strategies with triple-nucleoside reverse transcriptase inhibitor regimens in initial therapy were dominated. Results were sensitive to the price of 2bPIs. CONCLUSIONS: About 1 in 4 individuals who start highly active antiretroviral therapy in sub-Saharan Africa will fail currently recommended regimens. At current prices, adding a regimen with a 2bPI is cost effective for South Africa and other middle-income countries by WHO standards. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | THEORETICAL MODELS | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | ANTIRETROVIRAL DRUGS | ADMINISTRATION AND DOSAGE | COST EFFECTIVENESS | MONITORING | WHO | IMMUNOLOGICAL EFFECTS | LIFE EXPECTANCY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | HIV Infections | Viral Diseases | Diseases | HIV | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Drugs | Evaluation Indexes | Quantitative Evaluation | Evaluation | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Immunity | Immune System | Physiology | Biology | Length of Life | Mortality | Population Dynamics | Demographic Factors | Population Document Number: 342908 |
| 21. Peer Reviewed Title: Independent association between rate of clearance of infection and clinical outcome of HIV-associated cryptococcal meningitis: analysis of a combined cohort of 262 patients. Author: Bicanic T; Muzoora C; Brouwer AE; Meintjes G; Longley N; Taseera K; Rebe K; Loyse A; Jarvis J; Bekker LG; Wood R; Limmathurotsakul D; Chierakul W; Stepniewska K; White NJ; Jaffar S; Harrison TS Source: Clinical Infectious Diseases. 2009 Sep 1;49(5):702-9. Abstract: BACKGROUND: Progress in therapy for cryptococcal meningitis has been slow because of the lack of a suitable marker of treatment response. Previously, we demonstrated the statistical power of a novel endpoint, the rate of clearance of infection, based on serial quantitative cultures of cerebrospinal fluid, to differentiate the fungicidal activity of alternative antifungal drug regimens. We hypothesized that the rate of clearance of infection should also be a clinically meaningful endpoint. METHODS: We combined data from cohorts of patients with human immunodeficiency virus-associated cryptococcal meningitis from Thailand, South Africa, and Uganda, for whom the rate of clearance of infection was determined, and clinical and laboratory data prospectively collected, and explored the association between the rate of clearance of infection and mortality by Cox survival analyses. RESULTS: The combined cohort comprised 262 subjects. Altered mental status at presentation, a high baseline organism load, and a slow rate of clearance of infection were independently associated with increased mortality at 2 and 10 weeks. Rate of clearance of infection was associated with antifungal drug regimen and baseline cerebrospinal fluid interferon-gamma levels. CONCLUSIONS: The results support the use of the rate of clearance of infection or early fungicidal activity as a means to explore antifungal drug dosages and combinations in phase II studies. An increased understanding of how the factors determining outcome interrelate may help clarify opportunities for intervention. Language: English Keywords: SOUTH AFRICA | THAILAND | UGANDA | RESEARCH REPORT | CLIENTS | MENINGITIS | HIV INFECTIONS | DRUGS | INTERVENTIONS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Asia, Southeastern | Asia | Africa, Eastern | Program Activities | Programs | Organization and Administration | Central Nervous System Effects | Central Nervous System | Physiology | Biology | Viral Diseases | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 342967 |
| 22. Peer Reviewed Title: Effect of human immunodeficiency virus treatment on maternal mortality at a tertiary center in South Africa: a 5-year audit. Author: Black V; Brooke S; Chersich MF Source: Obstetrics and Gynecology. 2009 Aug;114(2 Pt 1):292-9. Abstract: OBJECTIVE:: To review facility-based maternal deaths at a tertiary-level center in Johannesburg, South Africa, during a 5-year period (2003 to 2007) and to investigate the proportion of deaths attributable to human immunodeficiency virus (HIV), the etiology of deaths, and the effects of antiretroviral treatment introduced in late 2004. METHODS:: Patient case files, birth registers, death certificates, and mortality summaries were reviewed. Cause of death was assigned through clinical case discussion. Annual maternal mortality ratios were calculated and disaggregated by HIV status. RESULTS:: During the 5-year period, 106 maternal deaths occurred out of 36,708 births (facility-based maternal mortality ratios 289/100,000 live births, 95% confidence interval [CI] 237-349/100,000). In 72% of cases, HIV status was known (76/106), with the majority being HIV-infected (78%, 59/76). Among HIV-infected women, only two had initiated antiretroviral treatment, and 70% of deaths were HIV-related (41/59), mainly from tuberculosis (21) and pneumonia (12). Direct obstetric causes of death such as hypertension and pregnancy-related sepsis predominated in women who were HIV-negative or of unknown status (48.9%, 23/47). Maternal mortality ratios in HIV-infected women were 776/100,000 (95% CI 591-1,000/100,000), 6.2-fold higher (95% CI 3.6-11.4) than in HIV-negative women (124/100,000, 95% CI 72-199/100,000). Changes in mortality over time were not detected. Although HIV testing increased 1.4-fold each year (95% CI 1.3-1.4) and estimated coverage of antiretroviral treatment for pregnant women reached 59.2% in 2007, levels remain suboptimal. CONCLUSION:: In Johannesburg, HIV remains the major cause of maternal mortality despite integration of antiretroviral treatment into prenatal services. Maternal health services should target barriers to uptake of HIV treatment and care. LEVEL OF EVIDENCE:: III. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | PREGNANT WOMEN | HYPERTENSION | MATERNAL-CHILD HEALTH SERVICES | HIV INFECTIONS | AIDS | MATERNAL MORTALITY | CAUSES OF DEATH | HIV/FP INTEGRATION | TREATMENT | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Population Characteristics | Demographic Factors | Population | Vascular Diseases | Diseases | Primary Health Care | Health Services | Delivery of Health Care | Health | Viral Diseases | Mortality | Population Dynamics | Medical Procedures | Medicine Document Number: 342270 |
| 23. Peer Reviewed Title: Emergence of a peak in early infant mortality due to HIV/AIDS in South Africa. Author: Bourne DE; Thompson M; Brody LL; Cotton M; Draper B; Laubscher R; Abdullah MF; Myers JE Source: AIDS. 2009 Jan 2;23(1):101-6. Abstract: OBJECTIVES: South Africa has among the highest levels of HIV prevalence in the world. Our objectives are to describe the distribution of South African infant and child mortality by age at fine resolution, to identify any trends over recent time and to examine these trends for HIV-associated and non HIV-associated causes of mortality. METHODS: A retrospective review of vital registration data was conducted. All registered postneonatal deaths under 1 year of age in South Africa for the period 1997-2002 were analysed by age in months using a generalized linear model with a log link and Poisson family. RESULTS: Postneonatal mortality increased each year over the period 1997-2002. A peak in HIV-related deaths was observed, centred at 2-3 months of age, rising monotonically over time. CONCLUSION: We interpret the peak in mortality at 2-3 months as an indicator for paediatric AIDS in a South African population with high HIV prevalence and where other causes of death are not sufficiently high to mask HIV effects. Intrauterine and intrapartum infection may contribute to this peak. It is potentially a useful surveillance tool, not requiring an exact cause of death. The findings also illustrate the need for early treatment of mother and child in settings with very high HIV prevalence. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | RETROSPECTIVE STUDIES | LINEAR REGRESSION | INFANT | PERSONS LIVING WITH HIV/AIDS | INFANT MORTALITY | AIDS | CAUSES OF DEATH | CHILD MORTALITY | VITAL STATISTICS | MOTHER-TO-CHILD TRANSMISSION | DEATH RATE | AGE SPECIFIC DEATH RATE | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Studies | Statistical Regression | Data Analysis | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Mortality | Population Dynamics | Population Statistics | Transmission | Infections Document Number: 330334 |
| 24. Title: Influence of transdermal rotigotine on ovulation suppression by a combined oral contraceptive. Author: Braun M; Elshoff JP; Andreas JO; Muller LI; Horstmann R Source: British Journal of Clinical Pharmacology. 2009 Sep;68(3):386-94. Abstract: AIMS: To assess the influence of the transdermally applied dopamine agonist rotigotine on ovulation suppression by a combined oral contraceptive (0.03 mg ethinyloestradiol and 0.15 mg levonorgestrel) in a randomized, double-blind crossover study in 40 healthy females. METHODS: Treatment A consisted of the combined oral contraceptive for 28 days plus rotigotine for the first 13 days (2 mg (24 h)(-1) on days 1-3, 3 mg (24 h)(-1) maintenance dose thereafter). During treatment B, subjects received matching placebo patches instead of rotigotine. Pharmacodynamic parameters (progesterone, oestradiol, luteinizing hormone, and follicle stimulating hormone serum concentrations), pharmacokinetic parameters for ethinyloestradiol/levonorgestrel and rotigotine, and safety and tolerability of the treatment were assessed. RESULTS: Progesterone serum concentrations remained below 2 ng ml(-1) in all subjects during the luteal phase. Median serum concentrations of all other pharmacodynamic parameters were similar during both treatments. Pharmacokinetic parameters C(max,ss) and AUC(0,24 h)(ss) at steady state were similar with or without co-administration of rotigotine for both ethinyloestradiol and levonorgestrel with geometric mean ratios close to 1 and 90% confidence intervals within the acceptance range of bioequivalence (0.8, 1.25): C(max,ss) 1.05 (0.93, 1.19), AUC(0,24 h)(ss) 1.05 (0.9, 1.22) for ethinyloestradiol; C(max,ss) 1.01 (0.96, 1.06), AUC(0,24 h)(ss) 0.98 (0.95, 1.01) for levonorgestrel. Mean plasma concentrations of unconjugated rotigotine remained stable throughout the patch-on period (day 13). CONCLUSIONS: Concomitant administration of 3 mg (24 h)(-1) transdermal rotigotine had no impact on the pharmacodynamics and pharmacokinetics of a combined oral contraceptive containing 0.03 mg ethinyloestradiol and 0.15 mg levonorgestrel, suggesting that the dopamine agonist does not influence contraception efficacy. Language: English Keywords: SOUTH AFRICA | SUMMARY REPORT | WOMEN | ORAL CONTRACEPTIVES, COMBINED | LEVONORGESTREL | ETHINYL ESTRADIOL | ADMINISTRATION AND DOSAGE | CONTRACEPTIVE SAFETY | TREATMENT | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Demographic Factors | Population | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraceptive Agents, Estrogen | Drugs | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Safety | Public Health Document Number: 342711 |
| 25. Title: Unhygienic male circumcision procedures and HIV transmission [letter] Author: Brewer DD; Potterat JJ; Roberts JM Jr; Brody S Source: South African Medical Journal. 2009 Jan;99(1):11-2. Abstract: This first letter to the editor discusses the tendency to emphasize either cost or effectiveness in the evaluation of medicines rather than a systematic analysis that incorporates both considerations. The second disputes the association between circumcision and HIV infection prevalence rates in South Africans and hypothesizes that often unhygienic circumcision procedures among black South Africans may facilitate HIV transmission. The third letter argues in favor of male circumcision and discusses the findings from the study from Orange Farm. Language: English Keywords: SOUTH AFRICA | CRITIQUE | PREVALENCE | YOUTH | HIV TRANSMISSION | HIV INFECTIONS | ETHICS | MALE CIRCUMCISION | RISK FACTORS | SURGERY | INTERVENTIONS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Measurement | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Sociocultural Factors | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Treatment | Programs | Organization and Administration Document Number: 341056 |
| 26. Peer Reviewed Title: Uptake of male circumcision in an HIV vaccine efficacy trial [letter] Author: Bruyn G; Martinson NA; Nkala BD; Tshabangu N; Shilaluka G; Kublin J; Corey L; Gray GE Source: Journal of Acquired Immune Deficiency Syndromes. 2009 May 1;51(1):108-10. Abstract: Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | CLINICAL TRIALS | MEN | HIV PREVENTION | MALE CIRCUMCISION | HIV INFECTIONS | VACCINES | SEX BEHAVIOR | RISK BEHAVIOR | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Clinical Research | Research Methodology | Demographic Factors | Population | Viral Diseases | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Behavior Document Number: 342348 |
| 27. Title: Community characteristics, sexual initiation, and condom use among young Black South Africans. Author: Burgard SA; Lee-Rife SM Source: Journal of Health and Social Behavior. 2009 Sep;50(3):293-309. Abstract: Individual and household-level characteristics that influence sexual behavior have been extensively studied in South Africa, but community characteristics have received limited attention. We use multilevel discrete time hazard models and multilevel logistic regression models to analyze data from a representative sample of young people in KwaZulu Natal, and from several sources of community data. Results suggest that, net of individual and household characteristics, higher levels of community concentrated disadvantage are associated with increased hazard of sexual initiation and higher risk of unprotected sex. Social disorder increases the hazard of sexual initiation, while greater community social cohesion is associated with delayed sexual debut, although the latter association appears stronger for young men than for young women. We discuss these results and the ways they vary from predictions based on US. theory in light of conditions prevailing in contemporary South Africa. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | DATA ANALYSIS | BLACKS | YOUTH | HOUSEHOLDS | SEX BEHAVIOR | AGE FACTORS | SOCIOECONOMIC FACTORS | RISK FACTORS | EXPOSURE | POPULATION CHARACTERISTICS | COMMUNITY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Ethnic Groups | Cultural Background | Demographic Factors | Population | Family and Household | Sociocultural Factors | Behavior | Economic Factors | Health | Residence Characteristics | Population Distribution | Geographic Factors Document Number: 342565 |
| 28. Peer Reviewed Title: Kaposi sarcoma-associated herpesvirus (KSHV) seroprevalence in population-based samples of African children: evidence for at least 2 patterns of KSHV transmission. Author: Butler LM; Dorsey G; Hladik W; Rosenthal PJ; Brander C; Neilands TB; Mbisa G; Whitby D; Kiepiela P; Mosam A; Mzolo S; Dollard SC; Martin JN Source: Journal of Infectious Diseases. 2009 Aug 1;200(3):430-8. Abstract: BACKGROUND: Kaposi sarcoma-associated herpesvirus (KSHV) infection is endemic among adult populations in Africa. A prevailing view is that childhood transmission is primarily responsible for the high seroprevalence of KSHV among adults that is observed throughout the continent. However, few studies have directly examined children, particularly in locations where KS is not commonly endemic. METHODS: Participants were children aged 1.5-8.9 years, including 427 children from a population-based sample in South Africa, 422 from a population-based sample in Uganda, and 567 from a clinic-based sample in Uganda. All serum specimens were tested by the same laboratory for KSHV antibodies with use of 2 enzyme immunoassays (against K8.1 and ORF65) and 1 immunofluorescence assay. RESULTS: KSHV seroprevalence was 7.5%-9.0% among South African children and was not associated with age. In contrast, in the Ugandan population-based sample, KSHV seroprevalence increased from 10% among 2-year-old children to 30.6% among 8-year-old children ([Formula: see text]). In the Ugandan clinic-based sample, seroprevalence increased from 9.3% among 2-year-old children to 36.4% among 8-year-old children ([Formula: see text]). CONCLUSION: Two distinct relationships between age and KSHV infection among children imply that KSHV transmission among children is not uniform throughout Africa and is therefore not always responsible for the high seroprevalence observed in adults. There are at least 2 patterns of KSHV transmission in Africa. Language: English Keywords: SOUTH AFRICA | UGANDA | RESEARCH REPORT | CHILDREN | HIV TESTING | LABORATORY PROCEDURES | HIV TRANSMISSION | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Africa, Eastern | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV Infections | Viral Diseases | Diseases Document Number: 342893 |
| 29. Title: Effect of micronutrient supplementation on diarrhoeal disease among stunted children in rural South Africa. Author: Chhagan MK; Van den Broeck J; Luabeya KK; Mpontshane N; Tucker KL; Bennish ML Source: European Journal of Clinical Nutrition. 2009 Jul;63(7):850-7. Abstract: BACKGROUND/OBJECTIVE: The efficacy of zinc combined with vitamin A or multiple micronutrients in preventing diarrhoea is unclear in African countries with high prevalence of human immunodeficiency virus (HIV)-exposed children. Potential modifying factors, such as stunting, need to be addressed. The objective of this study was to determine whether adding zinc or zinc plus multiple micronutrients to vitamin A reduces diarrhoea incidence, and whether this differs between the strata of stunted or HIV-infected children. METHODS: We analyzed data from a randomized, controlled, double-blinded trial (ClinicalTrials.gov NCT00156832) of prophylactic micronutrient supplementation to children aged 6-24 months. Three cohorts of children: 32 HIV-infected children, 154 HIV-uninfected children born to HIV-infected mothers and 187 uninfected children born to HIV-uninfected mothers, received vitamin A, vitamin A plus zinc or multiple micronutrients, which included vitamin A and zinc. The main outcome was incidence of diarrhoea. Poisson regression was used in intent-to-treat analyses. Stratified analyses followed testing for statistical interaction between intervention and stunting. RESULTS: We observed no significant differences in overall diarrhoea incidence among treatment arms. Stunting modified this effect with stunted HIV-uninfected children having significantly lower diarrhoea incidence when supplemented with zinc or multiple micronutrients compared with vitamin A alone (2.04 and 2.23 vs 3.92 episodes/year, respectively, P=0.024). No meaningful subgroup analyses could be done in the cohort of HIV-infected children. CONCLUSIONS: Compared with vitamin A alone, supplementation with zinc and with zinc and multiple micronutrients, reduced diarrhoea morbidity in stunted rural South African children. Efficacy of zinc supplementation in HIV-infected children needs confirmation in studies that represent the spectrum of disease severity and age groups. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | DOUBLE-BLIND STUDIES | INFANT | DIARRHEA, INFANTILE | INCIDENCE | HIV INFECTIONS | FOOD SUPPLEMENTATION | ZINC | VITAMIN A | VITAMINS AND MINERALS | ANTHROPOMETRY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Diarrhea | Diseases | Measurement | Viral Diseases | Nutrition Programs | Primary Health Care | Health Services | Delivery of Health Care | Health | Metals | Physiology | Biology Document Number: 342462 |
| 30. Peer Reviewed Title: Estimating HIV prevalence and risk behaviors among high-risk heterosexual men with multiple sex partners: use of respondent-driven sampling. Author: Chopra M; Townsend L; Johnston L; Mathews C; Tomlinson M; O'bra H; Kendall C Source: Journal of Acquired Immune Deficiency Syndromes. 2009 May 1;51(1):72-7. Abstract: OBJECTIVES: To collect HIV data from high-risk men who have multiple, younger, female sex partners in a periurban township in South Africa. DESIGN: Unlinked anonymous cross-sectional survey using respondent-driven sampling. METHODS: Survey conducted among men aged 18 years or older who reported having had sex with more than 1 female partner in the previous 3 months (one of whom was either 3 or more years younger than the participant or below the age of 24) and lived in the area of recruitment. RESULTS: The median age of the 421 recruited men was 28 years (range: 18-62 years). They reported a median of 6 sexual partners (range: 2-39) during the past 3 months, and 51% (confidence interval: 45.0 to 59.6) reported inconsistent condom use with their casual partners. During the 3 months before the survey, 98% of men reported having concurrent sexual relationships. HIV prevalence was 12.3% (confidence interval: 8.3% to 16.9%). Being older than 24 years and not using a condom during the last sexual intercourse with a 1-time sexual partner were significantly associated with HIV infection. CONCLUSIONS: This group of heterosexual urban men practice high levels of risky sexual behavior and are an important group that require more targeted HIV surveillance and prevention interventions. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | SAMPLING STUDIES | HETEROSEXUALS | MEN | URBAN POPULATION | HIV INFECTIONS | PREVALENCE | MULTIPLE PARTNERS | CONDOM USE | RISK BEHAVIOR | SEX BEHAVIOR | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Behavior | Demographic Factors | Population | Population Characteristics | Viral Diseases | Diseases | Measurement | Sexual Partners | Risk Reduction Behavior Document Number: 342370 |
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