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The contamination of paper products by various chemicals has been reported on a global level, but to date, no published research has investigated pharmaceutical contamination of paper-based products. In this study, pharmaceutical analysis was conducted on 42 samples collected from various points of the recycled paper value chain in Cape Town, South Africa, which included the various grades that may be included in the manufacturing of recycled paperboard. The analysis was achieved by ultrasonic-assisted extraction of paper samples before detection by UHPLC-Q Orbitrap. Quantification limits ranged from 1.15 pg/g for ketoprofen to 46.07 pg/g for methocarbamol. Pharmaceuticals identified in newspaper samples were dexamethasone, ketoprofen, and 17β-estradiol. The latter was also detected in paper shopping bags (up to 697.49 ng/g), infant bathtub packaging (280.62 ng/g), battery packaging (137.43 ng/g), and an egg carton (170.47 ng/g). Carbamazepine was also prominent with its concentration reaching 13.02 ng/g in a vegetable box. Suspect screening tentatively identified 14 additional pharmaceuticals in paper samples, with minocycline, prazepam, and anabolic steroids appearing more prominently. This pioneering study indicated that unintentional pharmaceutical exposure had expanded beyond environmental media to consumer products., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Nondumiso Mofokeng reports funding was provided by Mpact Operations Pty (Ltd). All other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Antibiotic resistance is a global threat, with a disproportionate burden of mortality in low- and middle-income countries. It is increasing in both the public and private healthcare sectors within South Africa, especially in Gram-negative organisms, and is associated with increased use of World Health Organization watch and reserve antibiotics. There is a need for improved access to new antibiotics to treat infections caused by drug-resistant organisms in order to limit side-effects and improve patient outcomes of currently available antibiotics. We propose the responsible introduction of these new antibiotics with both administrative and clinical oversight in order to preserve the longevity of these precious antibiotics.

Background: South Africa is reporting higher rates of adolescent pregnancy as compared to other countries. There are different types of interventions that are in place to address teenage pregnancy. However, these interventions were developed using top-down strategy without the inclusion of different stakeholders and adolescents which makes it hard to implement those interventions particularly in countries like South Africa. Hence, this study aimed to develop strategies to enhance sexual health education for prevention of teenage pregnancy in Vhembe District, Limpopo Province of South Africa., Methods: The research design of this study will be Co-operative Inquiry.The study will take place in Vhembe District in Limpopo province of South Africa through collaborating with a Non-governmental Organisation (NGO). The study population will be the teenagers and all the different stakeholders caring for teenagers in their areas of specialization. Purposive sampling will be used to sample the targeted participants of the study. The data collection method will be done in phases and focus group discussions will be used to collect data. Content analysis will be used to analyse data., Discussion: This study will add to the body of knowledge regarding the strategies that maybe used to enhance sexual health education for prevention of teenage pregnancy., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Pulp and paper mill sludge is a waste stream derived from the pulp and paper making industry, comprised of organic and inorganic material in the form of cellulose, hemicellulose, lignin and ash. In South Africa, approximately fivefour hundred thousand wet tonnes are produced per annum and is currently disposed via landfilling or incineration. However, these disposal methods raise environmental and financial concerns. This waste stream is an attractive feedstock for fermentable sugars, mainly glucose, recovery and can be redirected for valorisation as a feedstock for microbial fermentation to produce value-added products. Sugar recovery by enzymatic hydrolysis, as opposed to acidic hydrolysis, is a promising approach but is hampered by the lignin and inorganic material found in pulp and paper mill sludge. Several treatment steps to reduce or remove these components prior to enzymatic hydrolysis are assessed in this review. Pretreatment improves hydrolysis of cellulosic fibres and ensures a substantial yield of sugars., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Rapid reviews have emerged as an approach to provide contextualized evidence in a timely and efficient manner. Three rapid review centers were established in Ethiopia, Lebanon, and South Africa through the Alliance for Health Policy and Systems Research, World Health Organization, to stimulate demand, engage policymakers, and produce rapid reviews to support health policy and systems decision-making. This study aimed to assess the experiences of researchers and policymakers engaged in producing and using rapid reviews for health systems strengthening and decisions towards universal health coverage (UHC)., Methods: Using a case study approach with qualitative research methods, experienced researchers conducted semi-structured interviews with respondents from each center (n = 16). The topics covered included the process and experience of establishing the centers, stimulating demand for rapid reviews, collaborating between researchers and policymakers, and disseminating and using rapid reviews for health policies and interventions and the potential for sustaining and institutionalizing the services. Data were analyzed using thematic analysis., Results: Major themes interacted and contributed to shape the experiences of stakeholders of the rapid review centers, including the following: organizational structural arrangements of the centers, management of their processes as input factors, and the rapid reviews as the immediate policy-relevant outputs. The engagement process and the rapid review products contributed to a final theme of impact of the rapid review centers in relation to the uptake of evidence for policy and systems decision-making., Conclusions: The experiences of policymakers and researchers of the rapid review centers determined the uptake of evidence. The findings of this study can inform policymakers, health system managers, and researchers on best practices for demanding, developing and using rapid reviews to support decision- and policymaking, and implementing the universal healthcare coverage agenda., (© 2022. The Author(s).)

Background:  Basic palliative care teaching should be included in training curricula for health care providers (HCPs) at all levels of the health service to ensure that the goal set by the South African (SA) National Policy Framework and Strategy for Palliative Care, to have an adequate number of appropriately trained HCPs in South Africa, is achieved. Furthermore, palliative learning objectives for nurses and doctors should be standardised. Many SA medical schools have integrated elements of Palliative Medicine (PM) teaching into undergraduate medical training programmes for doctors; however, the degree of integration varies widely, and consensus and standardisation of the content, structure and delivery of such PM training programmes are not yet a reality., Aim:  This joint position paper aims to describe the current state of undergraduate medical PM teaching in South Africa and define the PM competencies required for an SA generalist doctor., Setting:  Palliative Medicine programme leads and teachers from eight medical schools in South Africa., Methods:  A survey exploring the structure, organisation and content of the respective medical undergraduate PM programmes was distributed to PM programme leads and teachers., Results:  Responses were received from seven medical schools. Through a process of iterative review, competencies were defined and further grouped according to suitability for the pre-clinical and clinical components of the curriculum., Conclusion:  Through mapping out these competencies in a spiralled medical curriculum, the authors hope to provide guidance to medical curriculum designers to effectively integrate PM teaching and learning into current curricula in line with the goals of the SA National Policy Framework and Strategy on Palliative Care (NPFSPC).

The purpose of this position paper by the South African Academy of Family Physicians (SAAFPs) is to inform decision making on human resources for health policy in South Africa and the placement of family physicians (FPs) in the district health system. National policies have been marred by misunderstanding of the roles and contribution of FPs; and there is unhelpful variability in how FPs are positioned in the health services between provinces. In the private sector, medical aid schemes have discriminated against FPs by failing to remunerate them as specialists and to recognise their scope of practice.

Introduction: Administering patient-reported outcome measures (PROMs) by text message may improve response rate in hard-to-reach populations. This study explored cultural acceptability of PROMs and compared measurement equivalence of the EQ-5D-3L administered on paper and by text message in a rural South African setting., Materials and Methods: Participants with upper or lower limb orthopaedic pathology were recruited. The EQ-5D was administered first on paper and then by text message after 24 h and 7 days. Differences in mean scores for paper and text message versions of the EQ-5D were evaluated. Test-retest reliability between text message versions was evaluated using Intraclass Correlation Coefficients (ICCs)., Results: 147 participants completed a paper EQ-5D. Response rates were 67% at 24 h and 58% at 7 days. There were no differences in means between paper and text message responses for the EQ-5D Index (p = 0.95) or EQ-5D VAS (p = 0.26). There was acceptable agreement between the paper and 24-h text message EQ-5D Index (0.84; 95% Confidence Interval (CI) 0.78-0.89) and EQ-5D VAS (0.73; 95% CI 0.64-0.82) and acceptable agreement between the 24-h and 7-day text message EQ-Index (0.72; CI 0.62-0.82) and EQ-VAS (0.72; CI 0.62-0.82). Non-responder traits were increasing age, Xhosa as first language and lower educational levels., Conclusions: Text messaging is equivalent to paper-based measurement of EQ-5D in this setting and is thus a viable tool for responders. Non-responders had similar socioeconomic characteristics and attrition rates to traditional modes of administration. The EQ-5D by text message offers potential clinical and research uses in hard-to-reach populations.

Vermitechnology is gaining recognition as an environmental friendly waste management strategy. Its successful implementation requires that the key operational parameters like earthworm stocking density be established for each target waste/waste mixture. One target waste mixture in South Africa is waste paper mixed with cow dung and rock phosphate (RP) for P enrichment. This study sought to establish optimal Eisenia fetida stocking density for maximum P release and rapid bioconversion of RP enriched cow dung-paper waste mixtures. E. fetida stocking densities of 0, 7.5, 12.5, 17.5 and 22.5 g-worms kg(-1) dry weight of cow dung-waste paper mixtures were evaluated. The stocking density of 12.5 g-worms kg(-1) resulted in the highest earthworm growth rate and humification of the RP enriched waste mixture as reflected by a C:N ratio of <12 and a humic acid/fulvic acid ratio of >1.9 in final vermicomposts. A germination test revealed that the resultant vermicompost had no inhibitory effect on the germination of tomato, carrot, and radish. Extractable P increased with stocking density up to 22.5 g-worm kg(-1) feedstock suggesting that for maximum P release from RP enriched wastes a high stocking density should be considered., (Copyright © 2014. Published by Elsevier Ltd.)

Phosphate rock is mined on a large scale as a source material for fertilizers and other phosphorous containing products, such as phosphoric acid and gypsum. The potential problem of high concentrations of naturally occurring radionuclides in the phosphate industry has been recognized for many years. The industry is responsible for the production of millions of tons of phosphogypsum waste, which is usually stockpiled and might impact the surrounding environment. The presented study aims to assess the natural radioactivity concentrations in raw and waste sub-products from phosphate mining and fertilizer production in South Africa and determine the potential radiological risk associated with the industry. Activity concentrations of 238 U, 226 Ra and 232 Th in phosphate rock, phosphogypsum, tailings, fertilizer, soil and sediment were found to be similar to values reported in previous studies conducted in South Africa. Concentrations of the 232 Th decay series were higher than those of the 238 U series in rock and ore. The low concentrations of 238 U and 226 Ra in rock and ore, compared to other countries, makes it more suitable to be used for fertilizer production, and therefore increases the demand for export of rock phosphate and fertilizer from South Africa. 228 Ra concentrations in phosphogypsum were higher than 226 Ra. The activity of 228 Ra was also enriched compared to 232 Th, with a ratio of 0.45-19.8. Similar equilibria as described in literature were observed, with almost all the 228 Ra and 226 Ra present in the phosphate rock observed in the phosphogypsum. Only a low percentage of 232 Th present in the original rock remained in the phosphogypsum, with more than 60% present in the fertilizer. The activity concentrations of all nuclides in the analysed samples from the phosphate industry were less than the 1000 Bq kg -1 exclusion value proposed internationally for regulation of NORM. With the exception of phosphate rock samples, concentrations in all solids were lower than the 500 Bq kg -1 limit proposed by the National Nuclear Regulator in South Africa. The obtained values of Ra eq for all phosphogypsum, tailings and soil samples were less than the recommended limit of 370 Bq kg -1 . The gamma index for the majority of samples was less than 0.5. The index exceeded the limit of unity only for phosphate rock and fertilizer samples, indicating some radiological risk to people living in the vicinity of the industry. The results suggested that members of the public were unlikely to receive any significant dose from the use of phosphate rocks and fertilizers, with an annual effective dose of less than 0.5 mSv.a -1 . The highest external dose of 0.45 mSv a -1 is expected from phosphate rock. The suitability of use of phosphogypsum as building material was evaluated. Based on the calculated gamma index [I γ  = 0.52 ± 0.14] use of phosphogypsum as building material is permitted., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: South Africa has a high HIV incidence and oral pre-exposure prophylaxis (PrEP) is available as public-sector standard of care. Access to alternative prevention methods for women may further reduce HIV acquisition., Setting: South African public sector., Methods: We performed a systematic search for high-quality up-to-date guidelines recommending dapivirine rings as PrEP using the Grading of Recommendations Assessment, Development, and Evaluation -Adolopment process. We appraised the systematic review and randomized controlled trial (RCT) evidence underpinning the selected guideline's recommendations and conducted a cost-effectiveness analysis. The Grading of Recommendations Assessment, Development, and Evaluation evidence-to-decision framework guided the adaptation of source guideline recommendations, according to our local context., Results: We identified the 2021 World Health Organization PrEP Guidelines, informed by 2 placebo-controlled RCTs, which were included in a contemporaneous systematic review. There were 23 fewer HIV acquisitions per 1000 clients with dapivirine ring vs placebo (95% confidence interval: 10 to 34), with no increase in adverse events (moderate certainty evidence). We found no RCTs comparing dapivirine to oral PrEP or among adolescent/pregnant/breastfeeding clients. Dapivirine is less cost-effective than oral PrEP at $14.59/ring, at the current price., Conclusions: The source guideline recommendation was adapted for the local context. Dapivirine ring seems to be less efficacious than oral PrEP, although comparative studies are lacking. Data on adolescents and pregnancy are also lacking, currently limiting the use of dapivirine as an alternative for women unable to take oral PrEP. At the current price, dapivirine is not cost-effective and unaffordable for inclusion in the South African Essential Medicines List., Competing Interests: H.D. was an investigator of the HPTN077 trial. The remaining authors have no funding or conflicts of interest to disclose., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

There are over 1.4 million adolescents living with HIV in sub-Saharan Africa, the majority of whom acquired the virus through perinatal transmission (PHIV). HIV stigma is particularly high among adolescents living with HIV and is associated with several outcomes that worsen health and increase the risk of onward HIV transmission. We tested associations between internalized HIV stigma and four of these outcomes over a one-year period among a sample of adolescent boys living with PHIV in Soweto, South Africa. Participants (N = 241) answered questions about internalized HIV stigma at baseline. They completed weekly mobile surveys over the following year to answer questions about their experiences with depression, binge drinking, medication adherence, and violence victimization. Using generalized linear mixed models, we found that baseline internalized HIV stigma was associated with increased odds of depression (OR 1.74), alcohol misuse (OR 2.09), and violence victimization (OR 1.44) and decreased odds of medication adherence (OR 0.60) over the course of a year. These outcomes negatively impact the health and wellbeing of adolescents living with PHIV and increase their risk of transmitting HIV to their partners in the future. Our findings provide novel, longitudinal evidence for the deleterious effects of HIV stigma. To improve health outcomes for adolescents with PHIV, it will be crucial to develop effective HIV stigma reduction interventions that address specific developmental, gendered, and cultural experiences., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Executive functions (EFs) in early childhood are predictors of later developmental outcomes and school readiness. Much of the research on EFs and their psychosocial correlates has been conducted in high-income, minority world countries, which represent a small and biased portion of children globally. The aim of this study is to examine EFs among children aged 3-5 years in two African countries, South Africa (SA) and The Gambia (GM), and to explore shared and distinct predictors of EFs in these settings. The SA sample (N = 243, 51.9% female) was recruited from low-income communities within the Cape Town Metropolitan area. In GM, participants (N = 171, 49.7% female) were recruited from the rural West Kiang region. EFs, working memory (WM), inhibitory control (IC) and cognitive flexibility (CF), were measured using tablet-based tasks. Associations between EF task performance and indicators of socioeconomic status (household assets, caregiver education) and family enrichment factors (enrichment activities, diversity of caregivers) were assessed. Participants in SA scored higher on all EF tasks, but children in both sites predominantly scored within the expected range for their age. There were no associations between EFs and household or familial variables in SA, except for a trend-level association between caregiver education and CF. Patterns were similar in GM, where there was a trend-level association between WM and enrichment activities but no other relationships. We challenge the postulation that children in low-income settings have poorer EFs, simply due to lower socioeconomic status, but highlight the need to identify predictors of EFs in diverse, global settings. RESEARCH HIGHLIGHTS: Assessed Executive Functioning (EF) skills and their psychosocial predictors among pre-school aged children (aged 3-5 years) in two African settings (The Gambia and South Africa). On average, children within each setting performed within the expected range for their age, although children in South Africa had higher scores across tasks. There was little evidence of any association between socioeconomic variables and EFs in either site. Enrichment activities were marginally associated with better working memory in The Gambia, and caregiver education with cognitive flexibility in South Africa, both associations were trend-level significance., (© 2023 The Authors. Developmental Science published by John Wiley & Sons Ltd.)

It is well evidenced that South Africa is characterised by extreme socioeconomic inequality, which is strongly racialised. We offer an original sociological perspective, which departs from established perspectives considering the dynamics of vulnerability and poverty to focus on the structuring of classed and racialised privilege. We map how stocks of economic, cultural, and social capital intersect to generate systematic and structural inequalities in the country and consider how far these are associated with fundamental racial divides. To achieve this, we utilise rich, nationally representative data from the National Income Dynamics Study and employ Multiple Correspondence Analysis to construct a model of South African 'social space'. Our findings underscore how entrenched racial divisions remain within South Africa, with White people being overwhelmingly located in the most privileged positions. However, our cluster analysis also indicates that forms of middle-class privilege percolate beyond a core of the 8% of the population that is white. We emphasise how age divisions are associated with social capital accumulation. Our cluster analysis reveals that trust levels increase with economic and cultural capital levels within younger age groups and could therefore come to intensify social and racial divisions., (© 2024 The Author(s). The British Journal of Sociology published by John Wiley & Sons Ltd on behalf of London School of Economics and Political Science.)

Apartheid had a devastating impact on medical education in South Africa. Until the development of the University of Natal Medical School in 1951, there were minimal opportunities for blacks (collectively Africans, Indians and so-called coloureds) to undertake undergraduate and postgraduate medical training in South Africa. At the height of apartheid (1968-1977), whites who had constituted 17% of the population, accounted for up to 87% of all medical graduates. The African majority, constituting 70% of the population had less than 5% of all medical graduates in South Africa. The global isolation of South Africa from the late 1940s further impacted negatively on the medical training for blacks in South Africa. During apartheid, the Government of India provided full scholarships to the marginalized in South Africa to study medicine in India. This initiative, coming at a time when India was grappling with its post-colonial challenges, was a remarkable yet seldom appreciated gesture.

South Africa has the largest share of people living with HIV in the world and this population is ageing. The social context in which people seek HIV care is often ignored. Apart from clinical interventions, socio-behavioural factors impact successful HIV care outcomes for older adults living with HIV. We use cross-sectional data linked with demographic household surveillance data, consisting of HIV positive adults aged above 40, to identify socio-behavioural predictors of a detectable viral load. Older adults were more likely to have a detectable viral load if they did not disclose their HIV positive status to close family members (aOR 2.56, 95% CI 1.89-3.46), resided in the poorest households (aOR 1.98, 95% CI 1.23-3.18), or were not taking medications other than ART (aOR 1.83, 95% CI 1.02-1.99) likely to have a detectable. Clinical interventions in HIV care must be supported by understanding the socio-behavioural barriers that occur outside the health facility. The importance of community health care workers in bridging this gap may offer more optimum outcomes for older adults ageing with HIV., (© 2024. The Author(s).)

Background: Kidney transplantation remains the treatment of choice for children with kidney failure (KF). In South Africa, kidney replacement therapy (KRT) is restricted to children eligible for transplantation. This study reports on the implementation of the Paediatric Feasibility Assessment for Transplantation (pFAT) tool, a psychosocial risk score developed in South Africa to support transparent transplant eligibility assessment in a low-resource setting., Methods: Single-center retrospective descriptive analysis of children assessed for KRT using pFAT tool from 2015 to 2021., Results: Using the pFAT form, 88 children (median [range] age 12.0 [1.1 to 19.0] years) were assessed for KRT. Thirty (34.1%) children were not listed for KRT, scoring poorly in all domains, and were referred for supportive palliative care. Fourteen of these 30 children (46.7%) died, with a median survival of 6 months without dialysis. Nine children were reassessed and two were subsequently listed. Residing >300 km from the hospital (p = .009) and having adherence concerns (p = .003) were independently associated with nonlisting. Of the 58 (65.9%) children listed for KRT, 40 (69.0%) were transplanted. One-year patient and graft survival were 97.2% and 88.6%, respectively. Only one of the four grafts lost at 1-year posttransplant was attributed to psychosocial issues., Conclusions: Short-term outcomes among children listed using the pFAT form are good. Among those nonlisted, the pFAT highlights specific psychosocial/socioeconomic barriers, over which most children themselves have no power to change, which should be systemically addressed to permit eligibility of more children and save lives., (© 2024 The Authors. Pediatric Transplantation published by Wiley Periodicals LLC.)

In South Africa, approximately 98% of the predicted total surface water resources are already being used up. Consequently, the National Water Resource Strategy considers groundwater to be important for the future planning and management of water resources. In this case, quantifying groundwater budgets is a prerequisite because they provide a means for evaluating the availability and sustainability of a water supply. This study estimated the regional groundwater budgets for the Inkomati-Usuthu Water Management Area (Usuthu, Komati, Sabie-Sand, and Crocodile) using the classical hydrological continuity equation. The equation was used to describe prevailing feedback loops between groundwater draft, recharge, baseflow, and storage change. The results were coarser scale estimates which, beforehand, were derived from the 2006 study. In the years to follow, groundwater reliance intensified and there was also the historic 2015/2016 drought. This inevitably led to an increased draft while the rest of the components of the groundwater budgets experienced decreases. Both Crocodile and Sabie-Sand experienced groundwater storage depletion which led to reduced baseflow and groundwater availability, while groundwater recharge contrarily increased due to capture. Conversely, the other two catchments experienced relatively lower drafts with correspondingly higher groundwater availability and recharge while storage change was positive. The results highlighted the need for adaptive water management whose effectiveness relies on predictive studies. Consequently, future models should be developed to capture the spatial and temporal dynamism of the natural groundwater budget due to climate change, water demands, and population growth predictions., (© 2024 National Ground Water Association.)

The BRICS countries-Brazil, Russia, India, China, and South Africa-are committed to achieving United Nations Sustainable Development Goal 13, which focuses on mitigating climate change. To attain this goal, it is crucial to emphasize the significance of ICT, renewable energy sources, industrialization, and institutional quality. This study contributes to the literature by examining the potential role of these factors in environmental sustainability in the BRICS economies from 2000 to 2021, utilizing cross-sectional augmented autoregressive distributed lag (CS-ARDL) estimation and other novel econometric techniques. Accordingly, the study suggests that BRICS governments and policymakers prioritize the use of ICT in the industrial and institutional sectors to achieve faster environmental sustainability in the short-run, as per the CS-ARDL results. However, the study advises caution in the long-term as the interaction between ICT and renewable energy sources, industrialization, and institutional quality may not favour environmental quality. Although the renewable energy sources interaction with ICT may not yield immediate progress, strong measures need to be taken to ensure that short-term gains are not nullified. In conclusion, the study highlights the potential of ICT, renewable energy sources, industrialization, and institutional quality in achieving environmental sustainability in the BRICS countries, while recommending cautious measures in the long run to safeguard the progress made., (© 2024. The Author(s).)

Abstract: Clinical associates (ClinAs) in South Africa are modeled after physician associates in the United States and the Netherlands and clinical officers elsewhere in Africa. The first ClinAs began their education in 2008 and started working in 2011. Three universities offer a 3-year bachelor of clinical medical practice degree. This article documents the nascent healthcare profession's origins, development, current status, and future. In the next decade, South Africa needs to address the challenges of ClinA supervision with tiered practice regulations, combat unemployment, and increase graduate retention by developing career paths., (Copyright © 2024 American Academy of Physician Associates.)

Background: The definition of Primary Health Care (PHC) issued by the World Health Organisation in 1978 indicated that essential health care should be made accessible to individuals and their communities close to where they live and work. In 1992 Starfield articulated the four pillars of PHC: the patient's first contact with healthcare, comprehensive care, coordinated care and continuous care. Using this literature guidance, this study sought to explore what undergraduate medical students and their clinical preceptors understood by PHC in four South African medical schools., Methods: A qualitative study using the phenomenological design was conducted among undergraduate medical students and their clinical preceptors. The setting was four medical schools in South Africa (Sefako Makgatho Health Sciences University, Walter Sisulu University and the University of KwaZulu-Natal and the Witwatersrand University). A total of 27 in-depth interviews were conducted among the clinical preceptors and 16 focus group discussions among the students who were in their clinical years of training (MBChB 4-6). Interviews were digitally recorded and transcribed verbatim, followed by thematic data analysis using the MAXQDA 2020 (Analytics Pro) software., Results: Four themes were identified in which there were similarities between the students and their preceptors regarding their understanding of PHC: (1) PHC as the patient's first contact with the healthcare system; (2) comprehensive care; (3) coordination of care and (4) continuity of care. A further two themes were identified in which these two groups were not of similar understanding: (5) PHC as a level or an approach to healthcare and (6) the role of specialist clinical preceptors in PHC., Conclusions: Medical students and their clinical preceptors displayed an understanding of PHC in line with four pillars articulated by Starfield and the WHO definition of PHC. However, there remains areas of divergence, on which the medical schools should follow the guidance provided by the WHO and Starfield for a holistic understanding of PHC., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Female sex workers (FSWs) face a confluence of multilevel barriers to HIV care. In South Africa, 63% of FSWs are living with HIV and <40% are virally suppressed. The objective of this analysis was to identify implementation determinants of 2 HIV treatment support strategies., Methods: The Siyaphambili trial tested a decentralized treatment provision and an individualized case management strategy aimed to support FSWs living with unsuppressed HIV viral loads. We identified a nested sample of trial participants using maximum variation sampling (n = 36) as well as a purposively selected sample of implementors (n = 12). We used semistructured interview guides, developed using the Consolidated Framework for Implementation Research (CFIR) and deductively coded the transcripts using CFIR, systematically assessing the strength and valence of implementation. We compared construct ratings to determine whether any constructs distinguished implementation across strategies., Results: Across 3 CFIR domains (innovation characteristics, inner setting, and outer setting), 12 constructs emerged as facilitating, hindering, or having mixed effects on strategy implementation. The relative advantage, design, adaptability, and complexity constructs of the innovation characteristics and the work infrastructure construct of the inner setting were strongly influential (±2 or +2). While the majority of construct valence and strength rating (9-12) were not distinguishing across strategies, we observed 3 weakly distinguishing CFIR constructs (relative advantage, complexity, and available resources)., Conclusions: Given the potential benefits of differentiated service delivery strategies, identifying the relative importance of implementation determinants facilitates transparency and evaluation, supporting future strategy design and implementation. Optimizing implementation will support addressing inequities in HIV care and treatment services., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

In the dictator game, the evidence that giving is equivalent to taking is mixed. The purpose of this study was to investigate framing effects (giving/taking) on social-discounting rates among young African adults from an informal settlement in South Africa. Employing a within-participant design, these young adults completed a series of incentivized dictator games with an isomorphically equivalent giving and taking frame at each of eight social distances. Altruism was measured by the social-discounting rate, and framing effects were assessed using generalized linear regression. The study provides empirical evidence that prosocial behavior among young South African adults is subject to framing because exponential, hyperbolic, and q-exponential social-discounting rates in all instances were lower in the taking than in the giving frame. This difference may be the result of greater "egalitarianism" and "selflessness" elicited by the taking frame, which likely is a product of the experiment's particular social and economic field context. More comparative research is required to establish the working of specific mechanics of morality that may operate differently in diverse socioeconomic contexts, thus contributing to elucidating the heterogeneous nature of findings in this area of study., (© 2024 The Author(s). Journal of the Experimental Analysis of Behavior published by Wiley Periodicals LLC on behalf of Society for the Experimental Analysis of Behavior.)

Purpose: We compared performance of the Roussel Uclaf Causality Assessment Method (RUCAM) with multidisciplinary expert panel review in identifying a drug-induced liver injury (DILI) due to antituberculosis therapy (ATT) and/or antiretroviral therapy (ART)., Methods: Cases were drawn from a prospective registry of hospitalised adults with suspected DILI due to ATT and/or ART in Cape Town, South Africa. Participants had to fulfil American Thoracic Society criteria for ATT interruption (alanine transaminase [ALT] ≥5 times upper limit of normal [ULN]/ALT ≥3 times [ULN] and symptomatic). Causality assessment by expert panel review served as reference standard. The panel ranked potentially implicated drugs as certain, probable, possible or unlikely causes guided by World Health Organization Uppsala Monitoring Centre criteria. The RUCAM was performed for each potentially implicated drug. We calculated sensitivity and specificity of the RUCAM in identifying a probable/certain drug cause for liver injury., Results: We included 48 participants. All were people with HIV (PWH). Twenty-seven were on concomitant ART and ATT, with a median of six potentially hepatotoxic drugs per case. Sensitivity and specificity of the RUCAM in identifying a probable/certain drug cause of liver injury compared with expert panel review was 7% and 100% respectively. Implicated drugs (times ranked probable/certain by panel) were isoniazid (18/0), pyrazinamide (17/0), rifampicin (15/1), efavirenz (6/4) and lopinavir/ritonavir (1/0)., Conclusions: PWH with liver injury received multiple potentially implicated drugs, which may increase liver injury risk and complicate causality assessment. Compared with expert panel review, the RUCAM had low sensitivity in detecting probable or certain drug causes of liver injury., (© 2024 The Author(s). Pharmacoepidemiology and Drug Safety published by John Wiley & Sons Ltd.)

Introduction: In low- and middle-income countries (LMICs), including South Africa, there is a paucity of psychosocial support services. Therefore, services are often provided in schools by non-government organisations like Community Keepers (CK). The COVID-19 pandemic and resultant restrictions meant that children and young people's (CYP) lives changed, negatively affecting their mental health. Further, organisations like CK had to change their working processes., Method: This project compared routinely collected data from CK from 2019 (pre-pandemic) to 2020 (pandemic) to describe the changes that occurred in referral patterns to, and service provision by, CK., Results: Both pre-pandemic and during the pandemic, most referrals of CYP were for emotional/psychological support and behavioural difficulties. In 2020, referrals for general guidance increased, whilst referrals for peer group issues and sexuality decreased. Further, CK completed more brief check-ins, provided wellbeing workshops to increased numbers of teachers, parents and CYP, and had more consultation sessions with other service providers during the pandemic., Discussion: Routinely collected data from this community-based service in a LMIC context shows differences in the way that support was provided, and to whom, during the COVID-19 pandemic. Clinical implications, including the importance of increasing access to psychosocial support via technology, are included., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: EW, ML, BC, and HG have no conflicts of interest to declare. Potential conflict of interest: GL is the Chief Executive Officer of Community Keepers. SH worked as a Registered Counsellor for Community Keepers on a part-time basis previously.

Objectives: The effects of HIV and antiretroviral therapy (ART) on microvascular function are poorly explored. We compared retinal vessel functional responses to flicker light-induced provocation (FLIP) in people living with HIV (PLWH) and people living without HIV (PLWoutH)., Methods: We included 115 PLWH and 51 PLWoutH with a median age of 41 years. Treated PLWH received similar first-line fixed-dose combination ART. Clinical characteristics and retinal vessels functional responses to FLIP were compared in (a) PLWH and PLWoutH; and (b) PLWH groups stratified by the median of (i) CD4-count (511 cells/mm 3 ), (ii) viral load (50 copies/mL), and (iii) ART duration (57.6 months)., Results: PLWH were older, smoked more, and had a lower prevalence of hypertension than PLWoutH (p < 0.05). Almost 64% of PLWH were infected for more than 5 years. Retinal vessel responses to FLIP were similar between PLWH and PLWoutH after taking confounders into account. In addition, PLWH subgroups stratified according to immuno-virological status by CD4-count, viral load, and ART duration showed no differences in retinal vessel responses to FLIP., Conclusion: Living with HIV and receiving ART were not associated with altered microvascular function as assessed with dynamic retinal vessel analysis in a South African case-control study., (© 2024 The Author(s). Microcirculation published by John Wiley & Sons Ltd.)

Concurrent testing of numerous genes for hereditary breast cancer (BC) is available but can result in management difficulties. We evaluated use of an expanded BC gene panel in women of diverse South African ancestries and assessed use of African genomic data to reclassify variants of uncertain significance (VUS). A total of 331 women of White, Black African, or Mixed Ancestry with BC had a 9-gene panel test, with an additional 75 genes tested in those without a pathogenic/likely pathogenic (P/LP) variant. The proportion of VUS reclassified using ClinGen gene-specific allele frequency (AF) thresholds or an AF > 0.001 in nonguidelines genes in African genomic data was determined. The 9-gene panel identified 58 P/LP variants, but only two of the P/LP variants detected using the 75-gene panel were in confirmed BC genes, resulting in a total of 60 (18.1%) in all participants. P/LP variant prevalence was similar across ancestry groups, but VUS prevalence was higher in Black African and Mixed Ancestry than in White participants. In total, 611 VUS were detected, representing 324 distinct variants. 10.8% (9/83) of VUS met ClinGen AF thresholds in genomic data while 10.8% (26/240) in nonguideline genes had an AF > 0.001. Overall, 27.0% of VUS occurrences could potentially be reclassified using African genomic data. Thus, expanding the gene panel yielded few clinically actionable variants but many VUS, particularly in participants of Black African and Mixed Ancestry. However, use of African genomic data has the potential to reclassify a significant proportion of VUS., (© 2024 The Author(s). Genes, Chromosomes and Cancer published by Wiley Periodicals LLC.)

The present research reexamines the validity of the EKC hypothesis in the top three polluted nations in Africa, Algeria, Egypt, and South Africa, over the period 1970-2020. The central idea of the research is to reexamine the EKC hypothesis by incorporating the ARMEY curve linking government spending and GDP into the Kuznets curve, as suggested by Işık et al. Environ Sci Pollut Res 29(11):16472-16483, (2022) and Ongan et al. Environ Sci Pollut Res 29(31):46587-46599, (2022). To this end, the ARDL equation with a Fourier function is implemented to estimate the long-run drivers of environmental deterioration. The Stochastic Impacts by Regression on Population, Affluence, and Technology (STIRPAT) model results revealed that the composite model is only valid in Algeria, and the optimal government spending that maximizes CO 2 emissions is 16.88% of gross domestic product. On the contrary, the results showed that the composite model is not valid for South Africa and Egypt due to the failure of the desired shapes for the three curves. The outcomes also confirm the role of energy consumption and population as key drivers of environmental degradation in the three countries., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

This study investigates the role of informality in the relationship among renewable and nonrenewable energy consumption, economic growth, and CO 2 emissions in a panel of 19 Eastern and South African countries. The empirical strategy exploits the panel generalized method of moments, panel fixed effects models using the Driscoll-Kraay standard errors, panel method of moments quantile regressions, and the Dumitrescu-Hurlin bootstrap panel Granger causality analysis. The results are fourfold. First, nonrenewable energy consumption is positively associated with CO 2 emissions, while renewable energy consumption is not. Second, there is a nonlinear ∩ -shaped relationship between economic growth and CO 2 emissions, consistent with the environmental Kuznets curve (EKC) hypothesis. Third, the results show a nonlinear ∪ -shaped relationship between informality and CO 2 emissions, suggesting that higher informality is associated with lower CO 2 emissions up to a certain critical point beyond which further increases in informality precipitate higher CO 2 emissions. Fourth, the results show unidirectional causality from CO 2 emissions to renewable energy, from CO 2 emissions to nonrenewable energy, from informality to CO 2 emissions, and feedback causality between GDP growth and CO 2 emissions., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: The similarities and differences in workforce trends in BRICS (Brazil, Russia, India, China, and South Africa) may offer reciprocal lessons for emerging economies., Methods: We used the Global Health Observatory data to assess the secular trends between 2001 and 2017 in the number of skilled health personnel (SHP: doctors, nurses/midwives) in BRICS compared to the average of Organization for Economic Co-operation and Development (OECD) countries., Results: Substantial efforts have been made in BRICS to increase SHP availability, as demonstrated by an average exponential growth rate (AEGR) > 0.03 in Brazil, China, and India compared to 0.01 in OECD. With an AEGR as high as 0.07 after 2008, China reached the level of SHP availability commensurate with the sustainable development goals (SDGs) in 2017. Other than China, BRICS countries had a mean number of nurses and midwives per doctor between 2001 and 2017 higher than or comparable to the OECD average (2.78). The corresponding number in China was 1.04 in 2017, lower than 2.21 in India in 2001., Conclusions: With China as the exception, BRICS countries maintained a sustainable skills mix of SHPs. China reached the level of SHP availability commensurate with the SDGs, but SHP's skill mix was imbalanced., (© 2023 John Wiley & Sons Ltd.)

The relationship between negative events, neighbourhood characteristics, and systolic blood pressure in developing countries is not well-documented, particularly using longitudinal data. To explore this relationship, we analysed panel data from the first three waves of the South African National Income Dynamics Study using a correlated random effects model adjusted for confounding risk factors. Our sample comprised of 15,631 respondents in 2008, 14,443 respondents in 2010/2011, and 14,418 respondents in 2012, all aged above 15 years. The prevalence of at least one negative household event across the three waves was approximately 30%. In any of the three waves, the adjusted prevalence of hypertension was 23.84%. This share was 21.75% in 2008 (95% CI 18.06-25.44), 23.16% in 2010/11 (95% CI 19.18-27.14), and 18.39% in 2012 (95% CI 16.03-20.75). In our adjusted correlated random effects model, we found that systolic blood pressure was significantly higher among respondents from households that reported death of a household member (0.85 mmHg; p =  0.02) and a reduction in grant income and remittances (2.14 mm Hg; p = 0.01). We also found no significant association between systolic blood pressure and neighbourhood income level. In a country with social and economic challenges, our results indicate that grief and negative financial events are adversely associated with blood pressure, which may explain in part the significant burden of hypertension in low- and middle-income countries., (© 2022. The Author(s), under exclusive licence to Springer Nature Limited.)

There has been a plethora of debate on the link between fiscal decentralization and a drop in carbon dioxide (CO 2 ) emissions, even though the evidence supporting this assertion is relatively sparse. Although the precise nature of this relationship is still up for discussion, economic hypothesis postulates that fiscal decentralization has an impact on environmental sustainability. Some researchers claim that fiscal decentralization could potentially result in a race to the top, while some believe it would lead to a race to the bottom. This analysis intends to shed light on the precise processes by which this connection may work in South Africa between 1960 and 2020 in light of current discussions in environmental and development economics. In contrary to previous studies, this paper employs a cutting-edge dynamic autoregressive distributed lag simulations methodology to evaluate the positive and negative variations in fiscal decentralization on CO 2 emissions. Our findings demonstrate the prevalence of the race to the top strategy by illustrating how fiscal decentralization has a bearing on CO 2 emissions reduction in the short and long terms. In accordance with the findings, greater fiscal decentralization should be implemented through the transfer of more powers to regional authorities, especially in the realm of environmental legislation considerations, in a bid to preserve South Africa's environmental integrity. By establishing a lower tier of government and defining roles at the federal and provincial divisions, South Africa could adopt strategies to improve green environment in an effort to fulfill the energy-saving tasks of fiscal expenditures., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

This study presents multiple sulphur isotope ( 32 S, 33 S, 34 S, 36 S) data on pyrites from silicified volcano-sedimentary rocks of the Paleoarchean Onverwacht Group of the Barberton greenstone belt, South Africa. These rocks include seafloor cherts and felsic conglomerates that were deposited in shallow marine environments preserving a record of atmospheric and biogeochemical conditions on the early Earth. A strong variation in mass independent sulphur isotope fractionation (MIF-S) anomalies is found in the cherts, with Δ 33 S ranging between -0.26‰ and 3.42‰. We explore possible depositional and preservational factors that could explain some of this variation seen in MIF-S. Evidence for microbial activity is recorded by the c. 3.45 Ga Hooggenoeg Formation Chert (HC4) preserving a contribution of microbial sulphate reduction (-Δ 33 S and -δ 34 S), and a c. 3.33 Ga Kromberg Formation Chert (KC5) recording a possible contribution of microbial elemental sulphur disproportionation (+Δ 33 S and -δ 34 S). Pyrites from a rhyo-dacitic conglomerate of the Noisy Formation do not plot along a previously proposed global Felsic Volcanic Array, and this excludes short-lived pulses of intense felsic volcanic gas emissions as the dominant control on Archean MIF-S. Rather, we suggest that the MIF-S signals measured reflect dilution during marine deposition, early diagenetic modification, and mixing with volcanic/hydrothermal S sources. Given the expanded stratigraphic interval (3.47-3.22 Ga) now sampled from across the Barberton Supergroup, we conclude that large MIF-S exceeding >4‰ is atypical of Paleoarchean near-surface environments on the Kaapvaal Craton., (© 2022 John Wiley & Sons Ltd.)

Abstract: Worldwide, radiographers' radiation protection practices vary. In South Africa, evidence of diagnostic radiographers' suboptimal radiation protection practices has been reported, but the reasons for these practices and suggestions to improve practices were lacking. Therefore, this study explored radiation protection among South African diagnostic radiographers. This study used an explanatory, sequential, mixed-method approach. Data were collected in three phases. Phase I, the quantitative phase, used an online questionnaire and respondents from Phase I interested in participating in Phase II, the qualitative phase, were interviewed, yielding 13 in-depth semi-structured telephone interviews. In Phase III, eight radiography managers co-constructed change strategies to optimize radiation protection in South Africa in two focus group interviews. Radiation protection was suboptimal despite diagnostic radiographers having a good attitude, subjective norm and perceived behavioral control toward radiation protection and optimal radiation protection knowledge. Varying attitudes to radiation protection, lack of resources, and support from radiography management and healthcare teams contributed to suboptimal radiation protection practices. Radiography managers suggested increasing radiation protection awareness, ameliorating the diminished stature of the radiographer in the healthcare team, and increasing the availability of optimal quality resources. South African diagnostic radiographers' radiation protection knowledge was optimal, but the implementation of radiation protection varied and was influenced by multiple factors. A radiation protection culture supported by management is advocated to optimize radiation protection. However, ultimately radiation protection practices are incumbent on the individual radiographers' choice to practice radiation protection., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Health Physics Society.)

This study investigates the effects of coal mining on environmental sustainability in South Africa in relation to the moderating role of institutions. To achieve the study's objectives, the fully modified least square (FMOLS), dynamic least squares (DOLS), canonical cointegrating regression (CCR), Bayer-Hanck cointegration and Toda-Yamamoto causality test are employed for the period 1984-2018. Results from the study show that coal mining contributes to environmental degradation in South Africa, while its interaction with institutional quality mitigates the severity of this negative impact. Furthermore, there is evidence that economic growth has a bidirectional causality with ecological footprint and coal mining, while institutional quality also Granger causes ecological footprint. To promote a sustainable environment, there is a need for the government and the institutions to form the foundation for the shift toward environmental sustainability, with particular attention paid to the development and implementation of greenhouse policy., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The main objective of this paper is to look at how environmental degradation in the form of climate change and air pollution affect international tourism for five countries such as Brazil, Russia, India, China, and South Africa (BRICS) over the years 1990-2019. Other independent variables include information and communication technology (ICT) and democracy. We also look at the role of environmental regulation to see the validity of porter hypothesis in the tourism sector. To achieve this objective, we apply a novel method of moments quantile regression approach as well as a robust causality technique. The result shows that at lower and medium quantile, CO 2 emission has positive impact on tourism while at higher quantile, CO 2 emission has negative but insignificant effect on tourism in BRICS countries. The result for PM2.5 is uniform across all the quantiles, showing the negative effect on tourism. ICT and human capital positively affect the tourism while democracy has negative impact on the tourism sector of the BRICS nations. The result also validated the Porter hypothesis for tourism sector. We conclude that tourism industry stakeholders and the environmental policymakers must work together to integrate tourism policies with BRICS countries' environmental conservation policies as part of the transition to sustainable tourism industry., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Access to safe drinking water sources and appropriate sanitation facilities remains a dream in low and middle-income countries including South Africa. This study identified the origin of faecal pollution by using quantitative polymerase chain reaction (qPCR) targeting host-specific Bacteroidales genetic markers to track the distribution of human-specific (BacHum) and animal-specific (cattle-BacCow, chicken-Cytb, pig-Pig-2-Bac, dog-BacCan) markers in water sources used by rural communities of the Vhembe District Municipality (VDM). Results revealed the prevalence of BacHum, BacCow, and BacCan in all surface water sources in Thulamela Local Municipality (TLM) and Collins Chabane Local Municipality (CLM) during wet (100%) and dry seasons (50-75%). Cytb was not detected in untreated spring water in TLM and CLM, and Pig-2-Bac was not detected in untreated hand-dug well water in TLM during both seasons. Household-level analysis detected Cytb (28.8% wet, 17.5% dry), BacHum (34.4% wet, 25% dry for Pig-2-Bac) in stored untreated spring water in CLM, and Cytb (42.9% wet, 28.5% dry) in untreated hand-dug well water in TLM. Despite differences in detection frequencies of host-specific Bacteroidales, the study highlights the public health concern of faecal pollution in rural VDM households., (© 2024. The Author(s).)

In this paper, it is aimed, for the first time, at deriving simple models, leveraging the trend analysis in order to estimate the future greenhouse gas emissions associated with coal combustion. Due to the expectations of becoming the center of global economic development in the future, BRICS-T (Brazil, the Russian Federation, India, China, South Africa, and Turkiye) countries are adopted as cases in the study. Following the models' derivation, their statistical validations and estimating accuracies are also tested through various metrics. In addition, the future greenhouse gas emissions associated with coal combustion are estimated by the derived models. The results demonstrate that the derived models can be successfully used as a tool for estimating the greenhouse gas emissions associated with coal combustions with accuracy ranges from at least 90% to almost 98%. Moreover, the estimating results show that the total amount of greenhouse gas emissions associated with coal combustions in the relevant countries and in the world will increase to 14 BtCO 2eq and 19 BtCO 2eq by 2035, with an annual growth of 2.39% and 1.71%, respectively. In summary, the current study's findings affirm the usefulness of trend analysis in deriving models to estimate greenhouse gas emissions associated with coal combustion., (© 2024. The Author(s).)

Background: As people with HIV grow older, stable engagement in care is essential for healthy aging. We evaluate the HIV care cascade for older adults in rural South Africa at 2 time points cross-sectionally and assess movement in the cascade over time., Setting: We evaluated the cascade stage at waves 1 (2014-2015) and 2 (2018-2019) of Health and Aging in Africa: A Longitudinal Study of an INDPETH Community in South Africa, a population-based longitudinal cohort study in Mpumalanga Province, South Africa., Methods: Biomarker screening defined cascade stages [HIV+/no antiretroviral therapy (ART); ART+/unsuppressed viral load; ART+/suppressed viral load]. Between-wave probability of death, cascade progression, regression, cascade transitions, and sociodemographic predictors were assessed with Poisson regression. The impact of death was considered using the Fine and Gray competing risk model., Results: We observed a higher prevalence of antiretroviral therapy with viral suppression over time (50% in wave 1 vs. 70% in wave 2). Among those alive, the oldest age group (70+ years old) was most likely to have cascade progression [adjusted risk ratio for treatment initiation vs. 40-49 years old: 1.38 (95% confidence interval: 1.02 to 1.86)]. However, there was a significant risk of death and cascade regression. Death between waves reached 40% for 70+-year-olds who were ART+/unsuppressed. In competing risk models, older age was associated with equivalent or less cascade progression., Conclusion: Older age groups who were unsuppressed on treatment and men had poorer cascade outcomes. Improvements observed in HIV treatment coverage over time for older adults must be interpreted in the context of the high risk of death for older HIV-positive adults, especially among those failing treatment., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: HIV testing rates among South African men lag behind rates for women and national targets. Community-based HIV self-screening (HIVSS) distribution and follow-up by community health workers (CHWs) is a scalable option to increase testing coverage, diagnosis, and treatment initiation. We provided HIVSS and assisted linkage to care to men not recently tested (within the past 12 months) residing in high-HIV-burden areas of Johannesburg., Methods: CHWs distributed HIVSS in 6 clinic catchment areas. Follow-up to encourage confirmatory testing and antiretroviral therapy initiation was conducted through personal support (PS) or an automated short message service (SMS) follow-up and linkage system in 3 clinic areas each. Using a quasi-experimental pre-post design, we compared differences in the proportion of men testing in the clinic catchment areas during the HIVSS campaign (June-August 2019) to the 3 months prior (March-May 2019) and compared treatment initiations by assisted linkage strategy., Results: Among 4793 participants accepting HIVSS, 62% had never tested. Among 3993 participants with follow-up data, 90.6% reported using their HIVSS kit. Testing coverage among men increased by 156%, from under 4% when only clinic-based HIV testing services were available to 9.5% when HIVSS and HIV testing services were available (z = -11.6; P < 0.01). Reported test use was higher for men followed through PS (99% vs. 68% in SMS); however, significantly more men reported reactive self-test results in the SMS group compared with PS (6.4% vs. 2.0%), resulting in more antiretroviral therapy initiations in the SMS group compared with PS (23 vs. 9; P < 0.01)., Conclusions: CHW HIVSS distribution significantly increases testing among men. While PS enabled personalized follow-up, reporting differences indicate SMS is more acceptable and better aligned with expectations of privacy associated with HIVSS., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Issue Addressed: The accessibility of opioid substitution therapy (OST), one of the recommended treatments for opioid dependence, remains low. This study sought to explore the perceived effectiveness of OST from the perspectives of peer outreach workers and OST clients in a community-based harm reduction programme., Methods: The research was done within the Community-Oriented Substance Use Programme (COSUP) in Tshwane, South Africa. Fifteen peer educators (13 males and 2 females) took part in two focus group discussions. Thereafter, there were semi-structured interviews in which 15 OST clients (11 males and 4 females) participated. A convenience cross-sectional study was used. Interviews were audio-recorded. Using thematic analysis, themes were examined to evaluate how OST and the harm reduction approach were perceived to contribute to the improved health status of people with opioid dependence., Results: Peer outreach workers and COSUP clients significantly endorsed OST as an effective treatment for opioid dependence. Participants perceived greater effectiveness of OST compared to abstinence-centred inpatient rehabilitation programmes. However, there were sentiments that more community education on OST was needed to motivate people with opioid dependence to access services and to address misconceptions about OST., Conclusions: There is a lack of multi-level and multi-sectoral engagement of various stakeholders in opioid dependence services, needed to accelerate utilisation of OST services. SO WHAT?: The research unpacks the need for an integrated approach to service use optimisation, and the need to evaluate the role that increased awareness and community education on harm reduction strategies can play in enhancing the utilisation of OST services., (© 2023 The Authors. Health Promotion Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of Australian Health Promotion Association.)

Streptococcus pneumoniae is a leading cause of pneumonia and meningitis worldwide. Many different serotypes co-circulate endemically in any one location 1,2 . The extent and mechanisms of spread and vaccine-driven changes in fitness and antimicrobial resistance remain largely unquantified. Here using geolocated genome sequences from South Africa (n = 6,910, collected from 2000 to 2014), we developed models to reconstruct spread, pairing detailed human mobility data and genomic data. Separately, we estimated the population-level changes in fitness of strains that are included (vaccine type (VT)) and not included (non-vaccine type (NVT)) in pneumococcal conjugate vaccines, first implemented in South Africa in 2009. Differences in strain fitness between those that are and are not resistant to penicillin were also evaluated. We found that pneumococci only become homogenously mixed across South Africa after 50 years of transmission, with the slow spread driven by the focal nature of human mobility. Furthermore, in the years following vaccine implementation, the relative fitness of NVT compared with VT strains increased (relative risk of 1.68; 95% confidence interval of 1.59-1.77), with an increasing proportion of these NVT strains becoming resistant to penicillin. Our findings point to highly entrenched, slow transmission and indicate that initial vaccine-linked decreases in antimicrobial resistance may be transient., (© 2024. The Author(s).)

More than 140 million children under five suffered from stunting in 2020. This highlights the ongoing challenge of addressing childhood malnutrition globally. We utilized data from a nationally representative sample of children under five years of age (n = 14,151) who participated in five cycles of the South African National Income Dynamics Study (SA-NIDS) (2008-2017). We estimated the proportion of stunted children attributed to the mothers' anthropometric characteristics and socioeconomic conditions. We also quantified the population-level burden of low-socioeconomic conditions on hunger/food insecurity among pregnant women (n = 22,814) who participated in the nine rounds of the South African General Household Surveys (GHS) (2008-2021). Results from weighted-multivariate logistic regression were incorporated into the population-level impacts of correlates of stunting and low-socioeconomic conditions. The prevalence of stunting declined from 25% in 2008 to 23% in 2017. Mothers' anthropometric measures (underweight/height < 160 cm), marital status, low education, absence of medical insurance and low-socioeconomic conditions were all identified as the most influential risk factors for stunting. Their population-level impacts on stunting increased substantially from 34% (in 2008) to 65% (in 2017). Comprehensive strategies emphasizing enhanced food security, extended breastfeeding, appropriate nutrition, and access to adequate healthcare and education are urgently needed to reduce the burden of food insecurity low-socioeconomic, malnutrition, and its long-term consequences., (© 2024. The Author(s).)

Purpose: The purpose of the paper was to conduct a legal-realist assessment of the South African prison system response to COVID-19. Severely congested and ill-resourced prison systems in Africa face unprecedented challenges amplified by COVID-19. South Africa has recorded the highest COVID-19 positivity rate in Africa and, on March 15th 2020, declared a national state of disaster. The first prison system case was notified on April 6th 2020., Design/methodology/approach: A legal-realist assessment of the South African prison system response to COVID-19 in the 12 months following initial case notification focused on the minimum State obligations to comply with human rights norms, and the extent to which human, health and occupational health rights of prisoners and staff were upheld during disaster measures., Findings: A legal-realist account was developed, which revealed the indeterminate nature of application of South African COVID-19 government directives, ill-resourced COVID-19 mitigation measures, alarming occupational health and prison conditions and inadequate standards of health care in prisons when evaluated against the rule of law during State declaration of disaster., Originality/value: This legal-realist assessment is original by virtue of its unique evaluation of the South African prison system approach to tackling COVID-19. It acknowledged State efforts, policymaking processes and outcomes and how these operated within the prison system itself. By moving beyond the deleterious impacts of the COVID-19 pandemic on the already precarious South African prison system, the authors argue for rights assurance for those who live and work in its prisons, improved infrastructure and greater substantive equality of all deprived of their liberty in South Africa., (© Emerald Publishing Limited.)

The Johannesburg Forensic Pathology Services medico-legal mortuary perform postmortem examinations on all cases of unnatural deaths in the greater Johannesburg metropolitan area, in South Africa. Unidentified decedents can comprise up to 10.0% of the total number of annual admissions at this medico-legal mortuary. To address the identification of the deceased, the Human Decedent Identification Unit (ID Unit) was created to perform secondary examinations for identification purposes. The aim of this study was to report on the identification methods and success rate of the ID Unit. Over a period of 31 months (January 2018-July 2020), unidentified decedents comprised 8.1% (n = 693) of all cases at the Johannesburg mortuary. The ID Unit processed 385 (55.6%) unidentified individuals during this period, who were mostly adult (100%), Black (94.5%), males (91.7%). DNA samples were successfully collected from most cases in the form of hair (96.4%; n = 371), blood (92.2%; n = 355), and nail samples (90.1%; n = 347). Fingerprints retrieved in 65.5% of cases (n = 252). Ultimately, 87 persons (22.6%) were positively identified. Fingerprinting was the most successful method of identification (98.9% of cases; n = 86). One positive identification was facilitated through DNA analysis. The nationalities of the positively identified decedents were from South Africa (52.9%; n = 46), Zimbabwe (5.7%), Uganda (1.1%), Mozambique (1.1%), Malawi (1.1%), South Sudan (1.1%), and undisclosed in 36.8% of cases. Through the collaborative efforts of all the agencies involved, the impact of the work of this ID Unit is vast-not only for South African authorities but most importantly for the decedents and their families., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)