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The aftermath of COVID changed how students learn, mainly moving to a distance learning model. The research reported in this paper investigated the organizational and individual factors that influence the preference for continuing with distance / online learning post-COVID. Partial least squares structural equation modeling was applied to a model developed for this research, based on data from 452 students from residential universities in South Africa. The key results reveal an overall reluctance to continue with distance learning. This is despite the technological and faculty support offered to university students and how distance learning fits their learning styles. This is likely due to student living conditions and their perception of low institutional concern. On the other hand, faculty support has a more substantial impact on continuance, compared with a generally negative perception of support from the universities. The research underscores the importance of addressing student reluctance to continue with distance learning by improving institutional support and tailoring learning styles. The research enhances our understanding of crucial factors influencing students' preference for distance/online learning post-COVID. It also underscores the pedagogical shifts brought about by the pandemic, particularly highlighting the changing roles of faculty support and the impact on students' living conditions. [ABSTRACT FROM AUTHOR]

Background: The traditional HIV treatment cascade aims to visualise the journey of each person living with HIV from diagnosis, through initiation on antiretroviral therapy (ART) to treatment success, represented by virological suppression. This representation has been a pivotal tool in highlighting and quantifying sequential gaps along the care continuum. There is longstanding recognition, however, that this may oversimplify the complexity of real-world engagement with HIV services in settings with mature high-burden HIV epidemics. A complementary "cyclical" cascade has been proposed to represent the processes of disengagement at different points on the care continuum, with multiple pathways to re-engagement, although the feasibility of implementing this at scale has been uncertain. This study aimed to populate, refine, and explore the utility of a cyclical representation of the HIV cascade, using routine data from a high-burden HIV setting. Methods and findings: This observational cohort study leveraged person-level data on all people living with HIV in the Western Cape (WC), South Africa, who accessed public health services in the 2 years prior to 31 December 2023. Programme data from disease registers were complemented by data from pharmacy and laboratory systems. At study closure, 494 370 people were included, constituting 93% of those of those estimated to be living with HIV in the province, of whom 355 104 were on ART. Substantial disengagement from HIV care was evident at every point on the cascade. Early treatment emerged as a period of higher risk of disengagement, but it did not account for the majority of disengagement. Almost all those currently disengaged had prior experience of treatment. While re-engagement was also common, overall treatment coverage had increased slowly over 5 years. The transition to dolutegravir-based regimens was dramatic with good virological outcomes for those in care, notwithstanding a clearly discernible impact of the Coronavirus Disease 2019 (COVID-19) pandemic on viral load (VL) testing. People currently engaged and disengaged in care are similar with respect to age and gender. Those who died or disengaged recently were previously distributed across a range of cascade statuses, and a substantial proportion of those newly initiating and re-initiating treatment were no longer on treatment 6 months later. The main limitation of this study was incomplete evidence of HIV testing, linkage to HIV-specific services, and out-of-facility mortality. Conclusions: Using routine data, it was possible to populate and automate a cyclical cascade of HIV care that continuously captured the nonlinear care journeys of individuals living with HIV. In this generalised mature HIV epidemic, most people are treatment experienced. Disengagement is common and occurs at various points along the cascade, making it challenging to identify high-impact intervention opportunities. While historical HIV cascades remain valuable for target setting and service monitoring, they can be complemented with insights from more detailed cyclical cascades. Jonathan Euvrard and colleagues leverage routinely collected data from a high-burden HIV setting to demonstrate the feasibility of populating a cyclical HIV care cascade as part of routine service provision and to identify care gaps and temporal trends and changes to cascade statuses. Author summary: Why was this study done?: While there had been broad enthusiasm for cyclical representations of the HIV care cascade, the feasibility and utility of populating such representations using routine data in high-burden settings like South Africa are unknown. What did the researchers do and find?: The researchers used routine person-level data from 494 370 people who recently accessed public health services in the Western Cape (WC), South Africa, to adapt and populate a cyclical cascade of HIV care. The study uncovered complex patterns of engagement, disengagement, and re-engagement at various cascade points. Early treatment emerged as a period of higher risk of disengagement, but it did not account for the majority of disengagement. Trends over time demonstrated the shift among those starting ART from first-ever HIV engagement to re-engagement and service disruptions resulting from the Coronavirus Disease 2019 (COVID-19) pandemic. What do these findings mean?: With an appropriate data consolidation environment within the health services, it is readily feasible to continuously populate a cyclical representation of the HIV cascade of care using routine administrative and clinical data. The findings provide insights into the complex nature of engagement with HIV care. The identification of disengagement at multiple points on the care journey suggests the need for scalable, inclusive interventions. While historical cascades remain important tools, the cyclical cascade offers a complementary understanding of engagement patterns, contributing to ongoing efforts to refine public health strategies and improve HIV care outcomes. The main limitation of this study was incomplete evidence of HIV testing, linkage to HIV-specific services and out-of-facility mortality. [ABSTRACT FROM AUTHOR]

Background: Covid-19 epidemics raged around the world in years 2020–2022. The dynamics of the epidemics and their mortality varied by country depending on prevention, treatments, vaccination and health status of the population. Objective: The study compares Covid-19 morbidity and mortality in South-Africa and in France, two countries with similar population size and with reliable reporting systems, in order to better understand the dynamics and impacts of the epidemics and the effects of health policies and programs. Data and methods: Data on cases, deaths, hospitalizations, vaccinations were drawn from national statistics. Published data on cases and deaths were corrected for undercount. Results: Results show a different epidemiology in the two countries in the first three years of the epidemic (2020–2022). Incidence was higher in South Africa, and some 44% more people were infected by December 2022 than in France. Mortality and case-fatality were also higher in South Africa despite a favourable age structure. The age pattern of mortality showed higher values in South Africa among the young adults. Young women appeared somewhat disadvantaged in South Africa. Lastly, vaccination appeared to have had no effect on incidence, but a large effect on case-fatality in France. Conclusions: Despite about the same population size and the same crude death rate at baseline, South Africa exhibited more cases and more deaths from Covid-19 over the 2020–2022 period. Prevention strategies (lockdown and vaccination) appear to have had large impacts on morbidity and mortality. [ABSTRACT FROM AUTHOR]