Search

Copyright of Disasters is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Policies for Universal Test & Treat (UTT) and same‐day initiation (SDI) of antiretroviral therapy (ART) were instituted in South Africa in September 2016 and 2017 respectively. However, there is limited evidence on whether these changes have improved patient retention after HIV diagnosis. Methods: We enrolled three cohorts of newly diagnosed HIV‐infected adults from two primary health clinics in Johannesburg from April to November 2015 (Pre‐UTT, N = 144), May‐September 2017 (UTT, N = 178) and October‐December 2017 (SDI, N = 88). A baseline survey was administered immediately after HIV diagnosis after which follow‐up using clinical records (paper charts, electronic health records and laboratory data) ensued for 12 months. The primary outcome was patient loss to follow‐up (being >90 days late for the last scheduled appointment) at 12 months post‐HIV diagnosis. We modelled attrition across HIV policy periods with Cox proportional hazard regression. Results: Overall, 410 of 580 screened HIV‐positive patients were enrolled. Overall, attrition at 12 months was 30% lower in the UTT guideline period (38.2%) compared to pre‐UTT (47.2%, aHR 0.7, 95% CI: 0.5 to 1.0). However, the total attrition was similar between the SDI (47.7%) and pre‐UTT cohorts (aHR 1.0, 95% CI: 0.7 to 1.5). Older age at HIV diagnosis (aHR 0.5 for ≥40 vs. 25 to 29 years, 95% CI: 0.3 to 0.8) and being in a non‐marital relationship (aHR 0.5 vs. being single, 95% CI: 0.3 to 0.8) protected against LTFU at 12 months, whereas LTFU rates increased with longer travel time to the diagnosing clinic (aHR 1.8 for ≥30 minutes vs. ≤15 minutes, 95% CI: 1.1 to 3.1). In analyses adjusted for the time‐varying ART initiation status, compared to the pre‐ART period of care, the hazard of on‐ART LTFU was 90% higher among participants diagnosed under the SDI policy compared to pre‐UTT (aHR 1.9, 95% CI: 1.1 to 2.9). Conclusions: Overall, nearly two‐fifths of HIV positive patients are likely to disengage from care by 12 months after HIV diagnosis under the new SDI policy. Furthermore, the increase in on‐ART patient attrition after the introduction of the SDI policy is cause for concern. Further research is needed to determine the best way for rapidly initiating patients on ART and also reducing long‐term attrition from care. [ABSTRACT FROM AUTHOR]

Introduction: South Africa has one of the highest rates of internal migration on the continent, largely comprised of men seeking labour in urban centres. South African men who move within the country (internal migrants) are at higher risk than non‐migrant men of acquiring HIV yet are less likely to test or use pre‐exposure prophylaxis (PrEP). However, little is known about the mechanisms that link internal migration and challenges engaging in HIV services. Methods: We recruited 30 internal migrant men (born outside Gauteng Province) during August 2022 for in‐depth qualitative interviews at two sites in Johannesburg (Gauteng) where migrants may gather, a factories workplace and a homeless shelter. Interviewers used open‐ended questions, based in the Theory of Triadic Influence, to explore experiences and challenges with HIV testing and/or PrEP. A mixed deductive inductive content analytic approach was used to review data and explain why participants may or may not use these services. Results: Migrant men come to Johannesburg to find work, but unreliable income, daily stress and time constraints limit their availability to seek health services. While awareness of HIV testing is high, the fear of a positive diagnosis often overshadows the benefits. In addition, many men lack knowledge about the opportunity for PrEP should they test negative, though they express interest in the medication after learning about it. Additionally, these men struggle with adjusting to urban life, lack of social support and fear of potential stigma. Finally, the necessity to prioritize work combined with long wait times at clinics further restricts their access to HIV services. Despite these challenges, Johannesburg also presents opportunities for HIV services for migrant men, such as greater anonymity and availability of HIV information and services in the city as compared to their rural homes of origin. Conclusions: Bringing HIV services to migrant men at community sites may ease the burden of accessing these services. Including PrEP counselling and services alongside HIV testing may further encourage men to test, particularly if integrated into counselling for livelihood and coping strategies, as well as support for navigating health services in Johannesburg. [ABSTRACT FROM AUTHOR]

Introduction: The study explored and described the professional identity of diagnostic radiographers in Johannesburg, Gauteng, South Africa. Methods: The methodology employed for the study was qualitative, exploratory and descriptive design. Face‐to‐face interviews were conducted with thirteen diagnostic radiographers from private, public practices and individually owned practices. Semi‐structured interviews were conducted, and the responses underwent thematic analysis and used Braun and Clarke's six steps for analysing qualitative data. Results: The thematic analysis revealed three themes and six categories. The three themes identified were: perceptions of identity, environment influences and organisational institutions. Conclusion: This study provided an insight into the current perspectives of the professional identity of diagnostic radiographers in Johannesburg, South Africa, which reflected a positive professional identity. The three themes identified could inform guidelines for education in diagnostic radiographers' professional identity in the future. [ABSTRACT FROM AUTHOR]

Background: Men of African descent are disproportionately affected by prostate cancer (PCa), and many have metastatic disease at presentation. In South Africa (SA), androgen deprivation therapy (ADT) is the first-line treatment for stage IV PCa. Objective: To identify predictors of overall survival (OS) in Black South African men with stage IV PCa treated with ADT. Design, Setting, and Participants: Men diagnosed with prostate cancer (3/22/2016–10/30/2020) at Chris Hani Baragwanath Academic Hospital in Soweto, Johannesburg, were recruited for the Men of African Descent with Cancer of the Prostate study. We included men with newly diagnosed stage IV PCa treated with ADT who had a prostate-specific antigen (PSA) level drawn prior to initiation of ADT and had ≥1 PSA drawn ≥12weeks after ADT start. Outcomes Measures and Statistical Analysis: We used Kaplan–Meier statistics to estimate OS and Cox regression models to identify predictors of OS. Results and Limitations: Of the 1097 men diagnosed with prostate cancer, we included 153 men with stage IV PCa who received ADT and met PSA requirements. The median age was 68.0 years (interquartile range 64–73 years). Median OS from time of ADT initiation was 3.39 years (95% confidence interval (CI): 3.14%–noncalculable), while biochemical progression-free survival was 2.36 years (95% CI: 2.03%–3.73%). Biochemical progression (HR 3.52, 95% CI: 1.85%–6.70%), PSA nadir level >4ng/mL (HR 3.77, 95% CI: 1.86%–7.62%), alkaline phosphatase level at diagnosis >150 IU/dL (HR 3.09, 95% CI: 1.64%– 5.83%), and hemoglobin at diagnosis <13.5 g/dL (HR 2.90, 95% CI: 1.28%–6.56%) were associated with worse OS. Conclusions: In this study, we identified factors associated with poor OS among Black South African men with stage IV PCa treated with ADT. These factors may be useful in identifying patients for upfront treatment escalation, including the use of docetaxel chemotherapy or escalation of therapy at the time of biochemical progression. Patient Summary: In this study, we found that high alkaline phosphatase level, anemia at diagnosis, and high PSA nadir after initiation of androgen deprivation therapy are associated with worse overall survival among Black South African men treated with androgen deprivation therapy for metastatic prostate cancer. [ABSTRACT FROM AUTHOR]

In January 2012 the residents of an inner-city tenement building in Doornfontein, Johannesburg, were evicted on a court order. The building was situated in a post-industrial neighbourhood in which thousands of South Africans and foreign nationals, many blind or disabled, live in unlawfully occupied buildings without access to water, basic sanitation, electricity and waste management services. Such buildings are known in policy discourse as 'bad buildings', and informally as 'dark buildings', invoking both a sense of developmental failure and spiritual insecurity. In this paper I analyse how urban renewal policies created social divisions and alliances not only among the residents of Chambers, which were channelled along nationalist lines, but also between the able-bodied and disabled, and produced new social alliances. In particular, I document how a group of blind Zimbabweans experienced threats of violence and accusations of betrayal, as they were offered alternate accommodation by the evicting company because of their disability. I argue here that the pressures of private-sector housing developments intersected with the insecurities and divisions of inner-city social spaces and also fostered new alliances. Following the work of Deleuze and Guattari, I invoke the concept of 'decoding dispossession', proposing that ongoing evictions and dispossessions are characterized by simultaneous movements of 'decoding and deterritorialization' and 'overcoding-reterritorialization'. [ABSTRACT FROM AUTHOR]

Pediatric ALF is rare but life‐threatening and may require urgent transplantation. In low and middle‐income countries, access to transplantation is limited, deceased organ donation rates are low, and data on outcomes scarce. The Wits Donald Gordon Medical Centre, in Johannesburg, is one of only two centers in South Africa that perform pediatric liver transplant. We describe the etiology, clinical presentation, and outcomes of children undergoing liver transplant for ALF at our center over the past 14 years. We performed a retrospective chart review of all children undergoing liver transplantation for ALF from November 2005 to September 2019. Recipient data included demographics, clinical and biochemical characteristics pretransplant, post‐operative complications, and survival. We conducted descriptive data analysis and used the Kaplan‐Meier method for survival analysis. We performed 182 primary pediatric liver transplants. Of these, 27 (15%) were for ALF, mostly from acute hepatitis A infection (11/27;41%). Just over half of the grafts were from living donors (15/27;56%), and five grafts (5/27;19%) were ABO‐incompatible. The most frequent post‐transplant complications were biliary leaks (9/27;33%). There were two cases of hepatic artery thrombosis (2/27;7%), one of whom required re‐transplantation. Unadjusted patient and graft survival at one and 3 years were the same, at 81% (95% CI 61%‐92%) and 78% (95% CI 57%‐89%), respectively. At WDGMC, our outcomes for children who undergo liver transplantation for ALF are excellent. We found workable solutions that effectively addressed our pervasive organ shortages without compromising patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Pollen monitoring has been discontinuously undertaken in South Africa, a country with high biodiversity, a seasonal rainfall gradient, and nine biomes from arid to subtropical. The South African Pollen Monitoring Network was set up in 2019 to conduct the first long‐term national aerospora monitoring across multiple biomes, providing weekly reports to allergy sufferers and healthcare providers. Methods: Daily airborne pollen concentrations were measured from August 2019 to August 2021 in seven cities across South Africa. Updated pollen calendars were created for the major pollen types (>3%), the average Annual Pollen Index over 12 months was calculated, and the results were compared to available historical data. Results: The main pollen types were from exotic vegetation. The most abundant taxa were Poaceae, Cupressaceae, Moraceae and Buddleja. The pollen season start, peak and end varied widely according to the biome and suite of pollen taxa. The main tree season started in the last week of August, peaked in September and ended in early December. Grass seasons followed rainfall patterns: September–January and January–April for summer and winter rainfall areas, respectively. Major urban centres, for example, Johannesburg and Pretoria in the same biome with similar rainfall, showed substantive differences in pollen taxa and abundance. Some major differences in pollen spectra were detected compared with historical data. However, we are cognisant that we are describing only 2 years of data that may be skewed by short‐term weather patterns. Conclusions: Differences in pollen spectra and concentrations were noted across biomes and between geographically close urban centres. Comparison with historical data suggests pollen spectra and seasons may be changing due to anthropogenic climate change and landscaping. These data stress the importance of regional and continuous pollen monitoring for informed care of pollinosis. [ABSTRACT FROM AUTHOR]

While community participation may serve as a vehicle to improve health and socioeconomic outcomes for residents in poor communities, little research exists on the individual factors that influence community participation, particularly in contexts where violence is exceptionally high. This study examined the relationship between sociodemographic characteristics, perceptions, and experiences of violence, neighborhood attachment, and community participation in a low‐income, under‐resourced neighborhood in Johannesburg South Africa. The study used baseline data from 300 randomly selected households and multiple linear regression to assess the relationship between individual factors and community participation. The results suggest a high level of community participation, with religious organizational membership the most common. Being female, employed, and fear of violent crime were positively associated with community participation. Future research should include mixed methods and transdisciplinary research approaches for building our understandings of social justice and transformation‐oriented community participation. [ABSTRACT FROM AUTHOR]

We extracted microplastics from surface water and sediment samples from the Vaal River in Johannesburg, South Africa. Average abundances of 0.61 ± 0.57 particles/m3and 4.6 × 102 ± 2.8 × 102 particles/kg dry weight were recorded for water and sediment samples, respectively. In both sediment and water samples, more than 80% of microplastics were fragments and fibers of smaller than 2 mm. High‐density polyethylene, low‐density polyethylene, and polypropylene were the dominant polymers identified in both sample types. In addition, polyethylene co‐vinyl acetate, polyester, polyurethane, and polyethylene/hexene‐1‐copolymer were also detected in sediment samples. Colored microplastics were the most commonly observed in both sample types; pigment yellow 83 was detected in surface water, and carbon black was detected in both sediment and water samples during Raman analysis. Taking into consideration the physical and chemical characteristics of the detected microplastics, their potential sources include inflow from tributaries, surface run‐off from urban city centers, recreational activities, and wastewater effluent from industries and households. Environ Toxicol Chem 2022;41:3029–3040. © 2022 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC. [ABSTRACT FROM AUTHOR]

This article interrogates the term "periphery" by examining the forms of urbanisation unfolding in the Gauteng City‐Region (GCR) of South Africa. Among the urbanisation processes identified, it focuses on two, situating them among debates on informality and defining new vocabularies of urbanisation. Aligned with discussions of peripherality as a social phenomenon, the article first depicts how some marginalised groups of people using transversal means carve out "toeholds" near urban centralities and opportunities. Second, it conveys how peripherality is also a geographical phenomenon, describing "aspirational" mass housing for the lower‐middle class on urban peripheries that can generate unexpected forms of precarity. The article concludes that toehold urbanisation and aspirational urbanisation drive peripheralisation in the GCR, and considers the implications of these concepts for critical geography and urban studies. [ABSTRACT FROM AUTHOR]

Introduction: Same‐day initiation (SDI) of antiretroviral therapy (ART) for HIV consistently increases ART uptake, but concerns remain about higher attrition from care after initiation. We analysed 12‐month retention in the SLATE SDI trials. Methods: SLATE I (Simplified Algorithms for Treatment Eligibility I, enrolment 06 March–28 July 2017) and SLATE II (enrolment 14 March–18 September 2018) were individually randomized trials at public outpatient clinics in Johannesburg that enrolled patients not yet on ART and administered the SLATE I or II algorithm. This included a symptom self‐report, medical history, brief physical examination and readiness questionnaire to assess the eligibility for SDI. The studies compared the offer of SDI using the SLATE algorithms to standard of care initiation procedures. ART uptake and early retention were previously reported. Using routine clinic records, we conducted a pooled analysis of retention in care and HIV viral suppression 14 months after study enrolment, a time point equivalent to 12 months potential on ART, with an additional month allowed on either end to initiate ART and to return for the 12‐month visit. Results and discussion: We enrolled 1193 study participants (standard arms, n = 599, 50%; intervention arms, n = 594, 50%) and analysed by originally assigned groups. By 14 months after enrolment, 50% of intervention arm patients and 46% of standard arm patients remained in care at the initiating site (crude risk difference 4% (95% confidence interval −1%‐10%); crude relative risk 1.10 (0.97–1.23), with similar viral suppression between arms. Observed attrition from care at site by 14 months was high in both study arms, but we found no evidence that the offer of SDI led to greater overall attrition or lower rates of viral suppression 1 year after starting ART and may have generated small improvements. SDI may have shifted some attrition from before to after dispensing of the first dose of medication. Conclusions: An offer of SDI of ART, following a carefully designed protocol to identify patients who are eligible and ready to start treatment, is not inherently associated with an overall increase in patient attrition from care and leads to similar rates of viral suppression. Trial registration: Clinicaltrials.gov NCT02891135, registered 01 September 2016. First participant enrolled 06 March 2017 in South Africa. Clinicaltrials.gov NCT03315013, registered 19 October 2017. First participant enrolled 14 March 2018. [ABSTRACT FROM AUTHOR]

Integrated reporting is a fairly recent phenomenon in the corporate reporting realm. Its dawn marks a new age of corporate reporting where financial and non‐financial information and their interrelation create an integrated and holistic approach for telling a value creation story. In tandem with this transformation, business sustainability in general and environmental performance, in particular, are also gaining prominence in the corporate landscape. This scholarly article investigates the relationship between integrated reporting and corporate environmental performance. A panel‐data is used to carry out the study using a sample of 110 firms listed on the Johannesburg Stock exchange for the years 2014–2018, where Integrated Reporting was first mandated. The empirical results are robust and consistent with our predictions in that integrated reporting is found positively associated with corporate environmental performance. Our findings pave the way for a new stream of literature on the transformation and the connectivity functions of integrated reporting. [ABSTRACT FROM AUTHOR]

Oral history presents an especially effective way of exploring the multitudinous, contradictory, and contextual meanings that are attached to the notion of community. In this study, we argue for narrative‐discourse analysis as a critical means of studying contested community memories. We rely on focus group discussions and individual interviews to explore oral histories of state‐sanctioned relocation of residents of Thembelihle, a low‐income community in Johannesburg, South Africa. Our analysis revealed the sharply splintered politics that characterizes oral histories of this community. We argue that oral histories, in their contradictory and visceral fullness, are able to point toward a politics of resistance that is sensitive to inequalities, and that are willed toward emancipatory future‐building. We conclude by underlining the need for community psychologists to engage with a politics of memory that is sensitive to power differentials, historiography, and broader currents of oppression. [ABSTRACT FROM AUTHOR]

Children who undergo liver transplantation and subsequently develop BSI are at risk for adverse outcomes. Research from high‐income settings contrasts the dearth of information from transplant centers in low‐ and middle‐income countries, such as South Africa. Therefore, this study from Johannesburg aimed to describe the clinical and demographic profile of children undergoing liver transplantation, and determine the incidence and pattern of BSI and associated risk factors for BSI during the first year after liver transplant. Pediatric liver transplants performed from 2005 to 2014 were reviewed. Descriptive analyses summarized donor, recipient, and post‐transplant infection characteristics. Association between BSI and sex, cause of liver failure, age, nutritional status, PELD/MELD score, graft type, biliary complications, and acute rejection was determined by Fisher's exact test; and association with length of stay by Cox proportional hazards regression analysis. Survival estimates were determined by the Kaplan‐Meier method. Sixty‐five children received one transplant and four had repeat transplants, totaling 69 procedures. Twenty‐nine BSI occurred in 19/69 (28%) procedures, mostly due to gram‐negative organisms, namely Klebsiella species. Risk for BSI was independently associated with biliary atresia (44% BSI in BA compared to 17% in non‐BA transplants; P =.014) and post‐operative biliary complications (55% BSI in transplants with biliary complications compared to 15% in those without; P =.0013). One‐year recipient and graft survival was 78% (CI 67%‐86%) and 77% (CI 65%‐85%), respectively. In Johannesburg, incident BSI, mostly from gram‐negative bacteria, were associated with biliary atresia and post‐operative biliary complications in children undergoing liver transplantation. [ABSTRACT FROM AUTHOR]

Background: Outcomes for the pediatric kidney transplant program in Johannesburg (1984‐2003) were found to be suboptimal. In this study, we compared (a) early (era 1:1984‐2003) to contemporary (era 2:2004‐2017) outcomes and (b) compared contemporary outcomes between the public and private sector hospitals in our program. Methods: We conducted a retrospective record review of all pediatric (<18 years) KA transplants performed in our kidney transplant program at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and Wits Donald Gordon Medical Centre (WDGMC) from 2004 to 2017. We collected the following data per site: number of recipients, transplants performed, mean follow‐up time, and grafts lost; per recipient: age at time of transplant, sex, self‐reported population group; transplant history; donor type; etiology of ESKD; recipient and graft survival. Outcomes for era 1 were based on data published on our kidney transplant program, based at CMJAH. Results: At CMJAH (public sector), there was no improvement in recipient and graft survival over time. In the contemporary analysis, 1‐, 5‐, and 10‐year recipient survival, as % (95% CI) was 93 (84‐97); 76 (64‐84); 59 (44‐70) for CMJAH, and 98 (90‐99); 95 (86‐99); 82 (54‐94) for WDGMC (private sector). Similarly, 1‐, 5‐ and 10‐year graft survival was 75 (63‐84); 55 (42‐66); 36 (24‐49) for CMJAH, and 96 (87‐99); 84 (73‐91); 64 (48‐76) at WDGMC. Conclusion: Contemporary outcomes for the pediatric kidney transplant program at WDGMC are comparable to outcomes achieved in middle‐ and high‐income settings. However, outcomes at CMJAH are suboptimal, reflecting numerous health system, infrastructural and human resource challenges. [ABSTRACT FROM AUTHOR]

Copyright of Tropical Medicine & International Health is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)