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The challenge of translating equity of access into equity of outcome with students from a differentially resourced secondary education system which may have advantaged or disadvantaged them in demonstrating their academic ability in the conventional matriculation/national senior certificate (NSC) examinations necessitated that Universities undertake a review of selection and admissions criteria within the "achievement vs. aptitude" as well as the "NATED vs. National Curriculum Statement (NCS)" discourses. The Faculty of Health Sciences conducted a longitudinal cohort study correlating matriculation/NSC scores, composite and component Alternative Admissions Research Project (AARP) scores and Standardized Assessment Test for Access and Placement (SATAP) English for Academic Purposes scores with average first year performance of all first entry students admitted into programmes offered in the Faculty of Health Sciences in 2008 (matriculants of the NATED curriculum) and 2009 (NSC holders of the outcomes-based education (OBE) curriculum). Results allow the Faculty to confidently use NSC scores as the primary selection tool for students who have received quality secondary education and students whose first language is English. The reasoning test (RT) and placement test in English for educational purposes (PTEEP) as well as composite AARP scores may be used to inform a selection of students whose second language is English and students admitted via alternative access routes respectively, noting that the AARP has since been replaced by the National Benchmark Test (NBT) which consists of commensurate components; thereby addressing equity and redress imperatives while ensuring throughput and success. (Contains 14 tables and 4 notes.)

The emergence of resistant microorganisms and its association with antimicrobial use is widely recognised as a global concern. Therefore, rational and regulated antimicrobial use is essential in both the public and private healthcare sectors in South Africa. A retrospective chart review was conducted of patients who were prescribed antibiotics over a two-month period. Prescriptions were assessed for adherence to the guidelines, either local or international, and/or to drug registration information, as a measure of rational prescribing practice. Accuracy of dose, and the frequency and duration of administration were evaluated, as were microbiologically informed treatment and de-escalation. 28.8% of patients (n = 226) received antibiotics during their intensive care unit (ICU) admission. A clear indication for antibiotic therapy was noted in 58.5% (n = 131) of the patients, of whom 70.2% were prescribed treatment consistent with the guidelines or drug registration information. Doses were deemed to be correct for 91.1% of the sample, microbiological investigations were evident for 61.2% of patients and de-escalation was noted in only 13.1% of the 70.8% of cases where de-escalation was indicated. Antibiotic prescription rates were relatively lower than those described in the international literature on antibiotic use in the ICU. Antibiotic prescription in the absence of indication in 41.1% of patients, the lack of microbiological verification in 38.8% of patients, inaccurate drug choice in 29.8% of the subset for whom antibiotics were indicated and incorrect dosing in 8.9% of the subset necessitates microbiologically informed therapy and compliance with the treatment guidelines. [ABSTRACT FROM AUTHOR]

Universities in South Africa, experience challenges related to throughput rates, especially in the first year of study. Student dropout in the School of Health Sciences (SHS) at the University of KwaZulu-Natal (UKZN) negatively affects the enrolment targets with the concomitant loss of student subsidy and fees. It also reduces the number of prospective healthcare professionals who are required to address the shortage of skilled healthcare workers in the country. Thus, this emphasises the need to determine secondary school factors that relate to success and throughput in the first year of study, namely: area and type of schooling; matriculation point scores (also referred to as admission point scores [APS}); and matriculation subject choices. A retrospective design with a quantitative approach was used to collect data from a total of 713 student records over the period 2009-2011. The quantitative data was analysed using descriptive and inferential statistics while Spearman's rank correlation coefficient (rho) and the Mann-Whitney U test were used to determine differences between variables related to academic success. A p-value of ≤ 0.05 was considered statistically significant. The data was analysed and presented as annual composite results as well as stratified by disciplines. Overall the area of secondary schooling did not correlate statistically significantly with academic success. In contrast, the type of secondary schooling (p = .012), matriculation points (p = .000) and all matriculation subjects investigated (p < .005) were statistically significant variables that correlated with academic success. At discipline-level, Physiotherapy was shown to have the most consistent correlations among variables, with a moderate correlation with matriculation subjects as well as the APS. The results of this study yielded evidencebased admissions criteria for students into the SHS at UKZN. [ABSTRACT FROM AUTHOR]

Physiology has an anecdotal track record of having lower pass rates than other professional modules in the Health Sciences (HS). The aim of this study was to compare the performance and associated contributory factors of students in physiology modules with professional modules at the same level of study. This was done by way of overall pass rates and average, maximum, and minimum marks for the period 2008-2010 stratified by programme/qualification, matriculation/National Senior Certificate achievement and language. The latter two served as proxies for alternative access and previously disadvantaged students, respectively. There was a notable difference in the mean 2008-2010 pass rates of students from the different professional qualifications and students generally performed considerably better in their professional modules as compared with their performance in the physiology modules. The performance in physiology modules of English first language (EFL) students was not significantly different from that of English second language students (ESL). The implications of these findings require further discourse on, inter alia, issues around physiology teaching; student learning modes; admission criteria; student preparedness for university; and student monitoring and support mechanisms. There also needs to be a greater interaction between physiologists and health professionals involved in the curriculum design. [ABSTRACT FROM AUTHOR]

Quality teaching and learning is critical to producing high calibre university graduates equipped with the knowledge, skills and values to contribute to the knowledge economy and the economic growth and development of countries while ensuring self-efficacy and personal success. Teaching quality measures and indicators have, however, not enjoyed adequate debate and discourse within the higher education sector, and, as such are largely quantitative and measured by proxy in university ranking systems. Proxy teaching indicators used by the Quacquarelli Symonds (QS) World University Rankings and the Times Higher Education (THE) World University Rankings were correlated with U-Multirank indicators applicable to the Faculty of Health Sciences for the period 2007-2011, with the faculty considered as a microcosm of the University of KwaZulu-Natal. There were no statistically significant differences in the indicators between years. There were just two significant correlations, viz., the ratio of PhD to Bachelors degrees awarded significantly correlated with throughput from cohort at 95 percent and 99 per cent while the number of PhDs significantly correlated with graduate employment at 90 per cent. Teaching quality measurement by proxy is thus justifiably contested in university rankings. The challenge for university ranking systems is thus: (1) identifying suitable quantitative and qualitative indicators for quality teaching; (2) striking the correct balance between quantitative and qualitative teaching quality indicators; and (3) ensuring that the quantitative/qualitative indicators address both teaching inputs and teaching impact/learning outcomes. [ABSTRACT FROM AUTHOR]

Quality teaching is a central tenet to the retention and success of students in higher education but teaching quality measures and indicators have not enjoyed sufficient debate and discourse within the higher education sector. The Faculty of Health Sciences at the University of KwaZulu-Natal investigated the use of various programme and module statistics as well as student and peer evaluations of teaching to inform quality improvements in teaching and learning. Quantitative data allowed benchmarking in relation to internal University targets and national norms and pointed to the student cohorts who collectively required teaching and learning interventions but was found to have limited use in improving individual teaching practice. Qualitative data from students and peers was best able to highlight strengths and weaknesses and provided the most useful data to inform changes in teaching practice as it engendered and enhanced reflective practice. The Organization for Economic Co-operation and Development (OECD) report on quality teaching in higher education found that most evaluation instruments were related to teaching input indicators and that there was a dearth of instruments to evaluate the impact of teaching, i.e. there was no explicit evaluation criteria linking teaching input to learning outcome. The challenge for the second cycle of institutional reviews/audits will thus be (1) identifying suitable qualitative indicators measures for quality teaching, (2) striking the correct balance between quantitative and qualitative teaching quality indicators/measures, and (3) ensuring that such indicators, both quantitative/qualitative address teaching impact/learning outcomes in addition to teaching inputs. [ABSTRACT FROM AUTHOR]

The National Plan for Higher Education (2001) mooted funding as a lever to engender equitable student access, quality teaching and research, improved student retention and throughput and the production of graduates responsive to the country's social and economic needs. Maximizing income via the teaching input and output grants, the research output grant and the institutional factor grants necessitates innovative strategies pre- and post student admission. Recruitment drives targeting schools with largely disadvantaged student populations, student selection using tools predictive of student success, comprehensive and holistic student support, and, curriculum and pedagogical interventions address both access and success within the equity and transformation paradigms, while also assuring financial viability of higher education institutions. This article describes the context and rationale behind the 'selection tools project', the 'academic development and student support prolect', the 'web-based/online Masters programme' and Faculty-specific rules for postgraduate degrees initiated in the Faculty of Health Sciences, delineating impact where possible. [ABSTRACT FROM AUTHOR]

High-quality care is essential for improving health outcomes, although many health systems struggle to maintain good quality. We use data from the People's Voice Survey-a nationally representative survey conducted in 14 high-income, middle-income, and low-income countries-to describe user-reported quality of most recent health care in the past 12 months. We described ratings for 14 measures of care competence, system competence, and user experience and assessed the relationship between visit quality factors and user recommendation of the facility. We disaggregated the data by high-need and underserved groups. The proportion of respondents rating their most recent visit as high quality ranged from 25% in Laos to 74% in the USA. The mean facility recommendation score was 7·7 out of 10. Individuals with high needs or who are underserved reported lower-quality services on average across countries. Countries with high health expenditure per capita tended to have better care ratings than countries with low health expenditure. Visit quality factors explained a high proportion of variation in facility recommendations relative to facility or demographic factors. These results show that user-reported quality is low but increases with high national health expenditure. Elevating care quality will require monitoring and improvements on multiple dimensions of care quality, especially in public systems., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: Amidst widespread public health recommendations and availability of COVID-19 vaccinations, half of South African adults are vaccinated against COVID-19. This study investigated the socio-behavioral determinants of vaccine hesitancy in South Africa, where vaccine hesitancy was separated into unwilling ness and uncertainty to take a COVID-19 vaccine., Methods: Data was collected from a large-scale public survey during June-October 2021 that included online and telephonic surveys. Vaccination hesitancy was based on the question "When available, would you take the COVID 19 vaccine?," with responses categorized into those who were willing, unwilling, and uncertain about taking a COVID-19 vaccine. Multinomial regression examined the association between socio-behavioral variables and vaccine hesitancy., Results: Overall, 73.8% reported they would definitely or probably take the vaccine, 16.4% were uncertain and 9.9% reported they probably or definitely would not ( n  = 16,988). Younger age, White and Colored population groups, no influenza vaccination history, previous vaccination refusal, knowing someone who experienced a serious vaccination side-effect, misperceptions about vaccine benefits, cultural or religious discouragement from taking a COVID-19 vaccination, lack of governmental confidence, concerns about side-effects, perceived lack of safety information, and lack of trust in the pharmaceutical industry and in the information from health care providers were all associated with higher odds of being uncertain and unwilling to take a COVID-19 vaccination. Strengths of association for unwillingness and uncertainty varied by the explanatory variables. Concern about effectiveness due to fast development was associated with uncertainty to take the vaccine but not with unwillingness. Concerns about side-effects had stronger associations with uncertainty than with unwillingness, while previous vaccine refusal, misperceptions of the protective benefits of vaccines, White population group, religious/cultural discouragement, and lack of trust in the pharmaceutical industry and health care providers' information had stronger associations with unwillingness than uncertainty., Conclusion: The determinants of COVID-19 vaccine hesitancy should be addressed in interventions to improve vaccine uptake. Public health interventions and health communication can be prioritized and tailored to the different forms of vaccination hesitancy., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Sewpaul, Sifunda, Gaida, Mokhele, Naidoo and Reddy.)

Todd Lewis and co-authors discuss development and use of the People's Voice Survey for health system assessment., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: MEK is a member of the Editorial Board of PLOS Medicine. EAO is acting as a Consultant to AstraZeneca. HHL is an Academic Editor for PLOS Global Public Health., (Copyright: © 2023 Lewis et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Population-based serological testing is important to understand the epidemiology and estimate the true cumulative incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to inform public health interventions. This study reports findings of a national household population SARS-CoV-2 serosurvey in people 12 years and older in South Africa. This cross-sectional multi-stage random stratified cluster survey undertaken from November 2020 to June 2021 collected sociodemographic data, medical history, behavioural data, and blood samples from consenting participants. The samples were tested for SARS-CoV-2 antibodies using the Roche ElecsysAnti-SARS-CoV-2 chemiluminescence immunoassay (CLIA) Total Antibody Test. The survey data were weighted by age, race, sex, and province with final individual weights benchmarked against the 2020 mid-year population estimates and accounted for clustering. Descriptive statistics summarize the characteristics of participants and seroprevalence. Logistic regression analyses were used to identify factors associated with seropositivity. From 13290 survey participants (median age 33 years, interquartile range (IQR) 23-46 years), SARS-CoV-2 seroprevalence was 37.8% [95% Confidence Interval (CI) 35.4-40.4] and varied substantially across the country's nine provinces, and by sex, age and locality type. In the final adjusted model, the odds of seropositivity were higher in women than in men [aOR = 1.3 (95% CI: 1.0-1.6), p = 0.027], and those living with HIV (self-report) [aOR = 1.6 (95% CI: 1.0-2.4), p = 0.031]. The odds were lower among those 50 years and older compared to adolescents 12-19 years old [aOR = 0.6 (95% CI: 0.5-0.8), p<0.001] and in those who did not attend events or gatherings [aOR = 0.7 (95% CI: 0.6-1.0), p = 0.020]. The findings help us understand the epidemiology of SARS-CoV-2 within different regions in a low-middle-income country. The survey highlights the higher risk of infection in women in South Africa likely driven by their home and workplace roles and also highlighted a need to actively target and include younger people in the COVID-19 response., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests. All authors were Funded by the Solidarity Fund and the Human Sciences Research Council. The National Institute for Communicable Diseases, South Africa, funded testing with the Roche assay Sizulu Moyo, Leickness C.S. Simbayi, Khangelani Zuma, Nompumelelo Zungu, Edmore Marinda E, Sean Jooste, Whadi-ah Parker, Shandir Ramlagan, Inbarani Naidoo, Musawenkosi Mabaso designed and led the study and were and are still employed by the Human Sciences Research Council. Mirriam Fortuin Beverley Singh, Adrian Puren led and conducted the laboratory testing and were and are still employed by the National Institute for Communicable Diseases, South Africa., (Copyright: © 2023 Moyo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The 2021 World Health Organization study on the impact of COVID-19 on older people (≥60 years) in the African region highlighted the difficulties they faced as the virus spread across borders and dominated the way of life. These difficulties included disruptions to both essential health care services and social support, as well as disconnections from family and friends. Among those who contracted COVID-19, the risks of severe illness, complications, and mortality were highest among near-old and older persons., Objective: Recognizing that older persons are a diverse group including younger- and older-aged individuals, a study was conducted to track the epidemic among near-old (50-59 years) and older persons (≥60 years) in South Africa covering the 2 years since the epidemic emerged., Methods: Using a quantitative secondary research approach, data for near-old and older persons were extracted for comparative purposes. COVID-19 surveillance outcomes (confirmed cases, hospitalizations, and deaths) and vaccination data were compiled up to March 5th, 2022. COVID-19 surveillance outcomes were plotted by epidemiological week and epidemic waves to visualize the overall growth and trajectory of the epidemic. Means for each age-group and by COVID-19 waves, together with age-specific rates, were calculated., Results: Average numbers of new COVID-19 confirmed cases and hospitalizations were highest among people aged 50-59- and 60-69-years. However, average age-specific infection rates showed that people aged 50-59 years and ≥80 years were most vulnerable to contracting COVID-19. Age-specific hospitalization and death rates increased, with people aged ≥ 70 years most affected. The number of people vaccinated was slightly higher among people aged 50-59 years before Wave Three and during Wave Four, but higher among people aged ≥ 60 years during Wave Three. The findings suggest that uptake of vaccinations stagnated prior to and during Wave Four for both age groups., Discussion: Health promotion messages and COVID-19 epidemiological surveillance and monitoring are still needed, particularly for older persons living in congregate residential and care facilities. Prompt health-seeking should be encouraged, including testing and diagnosis as well as taking up vaccines and boosters, particularly for high-risk older persons., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Abdelatif, Naidoo, Dunn, Mazinu, Essack, Groenewald, Maharaj, Msomi, Reddy, Roberts and Zuma.)

Background: Although tuberculosis (TB) symptoms have limited sensitivity they remain an important entry point into the TB care cascade., Objectives: To investigate self-reported healthcare seeking for TB symptoms in participants in a community-based survey., Methods: We compared reasons for not seeking care in participants reporting ≥1 of four TB screening symptoms (cough, weight loss, night sweats, fever) in the first South African national TB prevalence survey (2017-2019). We used logistic regression analyses to identify sociodemographic and clinical characteristics associated with healthcare seeking., Results: 5,168/35,191 (14.7%) survey participants reported TB symptoms and 3,442/5168 had not sought healthcare. 2,064/3,442(60.0%) participants intended to seek care, 912 (26.5%) regarded symptoms as benign, 399 (11.6%) reported access barriers(distance and cost), 36 (1.0%) took other medications and 20(0.6%) reported health system barriers. Of the 57/98 symptomatic participants diagnosed with bacteriologically confirmed TB who had not sought care: 38(66.7%) intended to do so, 8(14.0%) regarded symptoms as benign, and 6(10.5%) reported access barriers. Among these 98, those with unknown HIV status(OR 0.16 95% CI 0.03-0.82), p = 0.03 and those who smoked tobacco products(OR 0.39, 95% CI 0.17-0.89, p = 0.03) were significantly less likely to seek care., Conclusions: People with TB symptoms delayed seeking healthcare, many regarded symptoms as benign while others faced access barriers. Those with unknown HIV status were significantly less likely to seek care. Strengthening community-based TB awareness and screening programmes together with self-screening models could increase awareness of the significance of TB symptoms and contribute to improving healthcare seeking and enable many people with TB to enter the TB care cascade., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Moyo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Scheduled or routine childhood vaccinations are known for their effectiveness in eradicating fear for many life-threatening and disabling diseases and saving lives globally. This paper is aimed at assessing determinants of parents taking their children for scheduled vaccinations during the COVID-19 pandemic in South Africa. Data used for this paper were obtained from the Human Sciences Research Council's (HSRC) COVID-19 Online Survey titled "One Year Later Survey", which was conducted between 25 June and 11 October 2021 in South Africa. Multivariate logistic regression analysis was performed to achieve this study goal. Findings showed that just over half of parents (56.7%) reported taking their children for scheduled vaccinations across the country. Males were significantly less likely (aOR = 0.53 95% CI [0.45-0.61], p < 0.001) to have taken their children for scheduled vaccinations than females. Parents' experiences and views were among key determinants of parents having taken their children for scheduled vaccinations in South Africa. Parents who had never taken influenza (flu) vaccines were significantly less likely (aOR = 0.33 [0.28-039], p < 0.001) to have taken their children for scheduled vaccinations than those who had taken flu vaccines. Parents who did not know anyone who had personally experienced serious side effects to any vaccine were significantly less likely (aOR = 0.77 [0.66-0.90], p = 0.001) to have taken their children for scheduled vaccinations than those who knew anyone who had experienced them. Parents who did not think vaccines were a good way to protect communities from disease were significantly less likely (aOR = 0.50 [0.33-0.77], p = 0.001) to have taken their children for scheduled vaccinations than those who thought vaccines were a good way to protect communities from disease. These findings are of significance especially during the time when the country is still struggling to reach a substantial proportion of its population vaccinated for COVID-19. Thus, these findings may be relevant in determining parents' intentions to have their children receive the South African Department of Health recommended vaccines for their respective age group.

Social distancing behaviour is a primary preventive measure for reducing COVID-19 transmission. Improved understanding of factors associated with adherence to social distancing is vital for mitigating the impact of COVID-19 in South Africa. The study assessed adherence to social distancing and its associated factors during the state-implemented lockdown in South Africa. Data was analysed from a large-scale public survey conducted in South Africa from 8 to 29 April 2020, which was administered online and telephonically. Invitations to participate were distributed widely on local websites and social media networks, including on a data-free platform. Adherence to social distancing was measured by self-report of having engaged in close physical contact with someone outside the home. Simple and multiple logistic regression models examined the association between social distancing and potential explanatory variables. Of the 17,586 participants, 9.2% came into close physical contact with a person outside their home by hugging, kissing, or shaking hands during the past 7 days. The odds of coming into close physical contact with other people were significantly higher for males, students, and those with incorrect knowledge on physical distancing, angry attitudes about the lockdown, lack of confidence in the government response, high-risk perception, movement out of the local area, travelling to shops using public transport, households with communal water facilities and higher household size. The 25-59-year olds compared to 18-24-year olds, and the White and Indian/Asian compared to the African population groups had significantly lower odds of close physical contact with others outside the home. The study identifies subgroups of individuals for whom public health interventions to improve adherence to social distancing should be prioritised and tailored. Interventions and policies should take cognisance of the social determinants of health as well as culturally accepted greeting practices like hand shaking.

Objectives: This paper reports HIV prevalence, incidence, progress towards the UNAIDS (90-90-90) targets, and HIV drug resistance among adolescents living with HIV in South Africa. We conducted secondary analyses using data extracted from the South African national HIV prevalence surveys (2005-2017). Analyses were stratified by sex and age (10-14 and 15-19-years), presenting weighted descriptive statistics, and realised totals., Results: HIV prevalence increased from 3.0% in 2012 to 3.7% in 2017, translating to 360 582 (95% CI 302 021-419 144) HIV positive adolescents in 2017. Female adolescents bear a disproportionate HIV burden of 5.6% prevalence versus 0.7% for males. HIV incidence remained relatively stable. For the UNAIDS 90-90-90 targets, approximately 62.3% of adolescents knew their HIV status, 65.4% of whom were on antiretroviral therapy, and of these 78.1% on antiretroviral therapy had attained viral load suppression. There are knowledge gaps pertaining to the magnitude of perinatal infections and postnatal infections, and socio-behavioural risk factors for HIV transmission among adolescents in South Africa. There is still a need for focussed interventions targeting adolescent (1) gender disparities in HIV risk (2) screening for HIV, (3) sustained access and adherence to antiretroviral therapy and (3) retention in care to maintain viral load suppression., (© 2022. The Author(s).)

Background: Adolescents are at increased risk of HIV infection compared to other age groups. There is an urgent need for strategic information that will inform programmes to reduce risk and vulnerability to HIV and reverse the pattern of increasing HIV infection as they transition to adulthood. This paper analysed trends and factors associated with HIV prevalence among adolescents in South Africa using the national HIV population-based household surveys conducted in 2008, 2012 and 2017., Methods: All three surveys used a multistage cross-sectional design. A trend analysis was conducted to assess the differences in HIV prevalence and covariates overtime using P-trend Chi-squared statistic. Univariate and multivariate logistic regression models were used to determine factors associated with HIV prevalence., Results: Overall there was a significant increase in HIV prevalence among adolescents aged 12-19 years from 3.0% (n = 2892) in 2008 to 3.2% (n = 4829) in 2012 and 4.1% (n = 3937) in 2017 (p = 0.031). The odds of being HIV positive among adolescents aged 12-19 years was significantly higher among females [AOR = 2.24; 95% CI (1.73-2.91); p < 0.001] than males, those residing in KwaZulu-Natal province [AOR = 2.01; 95% CI (1.-3.99); p = 0.027] than Northern Cape, and those who did not attend an educational institution and were unemployed [AOR = 2.66; 95% CI (1.91-3.67); p < 0.001] compared to those attending an educational institution. The odds were significantly lower among Whites [AOR = 0.29; 95% CI (0.09-0.93); p = 0.037], Coloureds [AOR = 0.21; 95% CI (0.11-0.37); p ≤ 0.001] and Indian/Asian [AOR = 0.08; 95% CI (0.02-0.34); p = 0.001] population groups than Black Africans., Conclusion: The observed increasing trend and gender disparities in HIV prevalence suggests an urgent need for age appropriate and gender specific HIV interventions tailored and targeted at identified drivers of HIV infection among adolescents., (© 2021. The Author(s).)

Background: During pregnancy and postpartum period, the sexual behaviors of women and their partners change in ways that may either increase or reduce HIV risks. Pregnant women are a priority population for reducing both horizontal and vertical HIV transmission., Setting: Nine sites in 4 South African provinces., Methods: Women aged 18-30 years were randomized to receive pericoital tenofovir 1% gel or placebo gel and required to use reliable modern contraception. We compared HIV incidence in women before, during, and after pregnancy and used multivariate Cox Proportional hazards models to compare HIV incidence by pregnancy status., Results: Rates of pregnancy were 7.1 per 100 woman-years (95% confidence interval [CI]: 6.3 to 8.1) and highest in those who reported oral contraceptive use (25.1 per 100 woman-years; adjusted hazard ratio 22.97 higher than other women; 95% CI: 5.0 to 105.4) or had 2 children. Birth outcomes were similar between trial arms, with 59.8% having full-term live births. No difference was detected in incident HIV during pregnancy compared with nonpregnant women (2.1 versus 4.3%; hazard ratio = 0.56, 95% CI: 0.14 to 2.26). Sexual activity was low in pregnancy and the early postpartum period, as was consistent condom use., Conclusions: Pregnancy incidence was high despite trial participation being contingent on contraceptive use. We found no evidence that rates of HIV acquisition were elevated in pregnancy when compared with those in nonpregnant women. Risks from reductions in condom use may be offset by reduced sexual activity. Nevertheless, high HIV incidence in both pregnant and nonpregnant women supports consideration of introducing antiretroviral-containing pre-exposure prophylaxis for pregnant and nonpregnant women in high HIV prevalence settings., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Social or physical distancing has been an effective measure for reducing the spread of COVID-19 infections. Investigating the determinants of adherence to social distancing can inform public health strategies to improve the behaviour. However, there is a lack of data in various populations. This study investigates the degree to which South Africans complied with social distancing during the country's COVID-19 lockdown and identifies the determinants associated with being in close contact with large numbers of people. Materials and Methods: Data was collected from a South African national online survey on a data free platform, supplemented with telephone interviews. The survey was conducted from 8 to 29 April 2020. The primary outcome was the number of people that participants came into close contact with (within a 2-metre distance) the last time they were outside their home during the COVID-19 lockdown. Multivariate multinomial regression investigated the socio-demographic, psychosocial and household environmental determinants associated with being in contact with 1-10, 11-50 and more than 50 people. Results: Of the 17,563 adult participants, 20.3% reported having not left home, 50.6% were in close physical distance with 1-10 people, 21.1% with 11-50 people, and 8.0% with >50 people. Larger household size and incorrect knowledge about the importance of social distancing were associated with being in contact with >50 people. Male gender, younger age and being in the White and Coloured population groups were significantly associated with being in contact with 1-10 people but not with larger numbers of people. Employment, at least secondary school education, lack of self-efficacy in being able to protect oneself from infection, and moderate or high risk perception of becoming infected, were all associated with increased odds of close contact with 1-10, 11-50, and >50 people relative to remaining at home. Conclusion: The findings identify subgroups of individuals that are less likely to comply with social distancing regulations. Public health communication, interventions and policy can be tailored to address these determinants of social distancing., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Sewpaul, Mabaso, Dukhi, Naidoo, Vondo, Davids, Mokhele and Reddy.)

Background: Adequate information and knowledge about COVID-19 has been shown to induce the confidence and positive performance among healthcare workers (HCWs). Therefore, assessing the relationship between confidence in knowledge and associated factors among HCWs is vital in the fight against COVID-19. This paper investigates factors associated with HCWs' confidence in their overall knowledge about COVID-19 in South Africa in the early stages of the epidemic. Methods: Data utilized in this paper were from an online survey conducted among HCWs using a structured questionnaire on a data free online platform. The study population were all the medical fraternity in South Africa including medical and nurse practitioners as well as other healthcare professionals. Bivariate and multivariate logistic regression models were performed to examine the factors associated with confidence in HCWs' overall knowledge about COVID-19. Results: Overall, just below half (47.4%) of respondents indicated that they had confidence in their overall knowledge about COVID-19. Increased odds of having confidence in the knowledge about COVID-19 were significantly associated with being male [aOR = 1.31 95% CI (1.03-1.65), p < 0.05], having a doctorate degree [aOR = 2.01 (1.23-3.28), p < 0.05], being satisfied with the information about COVID-19 guidelines [aOR = 6.01 (4.89-7.39), p < 0.001], having received training in 6-8 areas [aOR = 2.54 (1.89-3.43), p < 0.001] and having received training in 9-11 areas [aOR = 5.33 (3.81-7.47), p < 0.001], and having already treated COVID-19 patients [aOR = 1.43 (1.08-1.90), p < 0.001]. Those who were highly concerned with the levels of training of HCWs [aOR = 0.47 (0.24-0.92), p < 0.05] had decreased odds of having confidence in their overall knowledge about COVID-19. Conclusion: This study sheds light on the importance of capacitating HCWs with knowledge and adequate relevant training as part of infection prevention control measures during pandemics. Future training and information sharing should be sensitive to knowledge gaps by age, gender, qualifications, professional categories, and experience., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Manyaapelo, Mokhele, Sifunda, Ndlovu, Dukhi, Sewpaul, Naidoo, Jooste, Tlou, Moshabela, Mabaso, Zuma and Reddy.)

Background: The World Health Organization (WHO) declared the COVID-19 pandemic a public health emergency of international concern. South Africa, like many other countries, initiated a multifaceted national response to the pandemic. Self-isolation and quarantine are essential components of the public health response in the country. This paper examined perceptions and preparedness for self-isolation or quarantine during the initial phase of the pandemic in South Africa., Methods: The analysis used data obtained from an online quantitative survey conducted in all nine provinces using a data-free platform. Descriptive statistics and multivariable logistic regression models were used to analyse the data., Results: Of 55,823 respondents, 40.1% reported that they may end up in self-isolation or quarantine, 32.6% did not think that they would and 27.4% were unsure. Preparedness for self-isolation or quarantine was 59.0% for self, 53.8% for child and 59.9% for elderly. The odds of perceived possibility for self-isolation or quarantine were significantly higher among Coloureds, Whites, and Indians/Asians than Black Africans, and among those with moderate or high self-perceived risk of contracting COVID-19 than those with low risk perception. The odds were significantly lower among older age groups than those aged 18-29 years, and those unemployed than fully employed. The odds of preparedness for self-isolation or quarantine were significantly less likely among females than males. Preparedness for self, child and elderly isolation or quarantine was significantly more likely among other population groups than Black Africans and among older age groups than those aged 18-29 years. Preparedness for self, child and elderly isolation or quarantine was significantly less likely among those self-employed than fully employed and those residing in informal dwellings than formal dwellings. In addition, preparedness for self-isolation or quarantine was significantly less likely among those with moderate and high self-perceived risk of contracting COVID-19 than low risk perception., Conclusion: The findings highlight the challenge of implementing self-isolation or quarantine in a country with different and unique social contexts. There is a need for public awareness regarding the importance of self-isolation or quarantine as well as counter measures against contextual factors inhibiting this intervention, especially in impoverished communities.