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Serological tests based on the enzyme immunoassay (EIA) are the primary tool for the diagnosis of human immunodeficiency virus (HIV) in adults and have rapidly evolved to quicker, affordable and more accurate test formats to detect early HIV infection. Second- and third-generation HIV rapid tests detect the immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies to the HIV and are used at the point of care and in HIV self-testing. The tests are affordable and accessible in state and private diagnostic laboratories. The present-day fourth- and fifth-generation EIAs can detect both p24 antigen and IgG and IgM HIV antibodies and thereby diagnose early HIV infection at approximately 2 weeks. The fourth- and fifth-generation EIAs also report sensitivity and specificity of more than 99%. The correct interpretation of HIV diagnosis of false-positive and false-negative EIA test results requires collaborative scrutiny of patient factors and laboratory test methodologies.

Leprosy (Hansen’s disease) can affect multiple organs and body structures. Skin signs are typically observed in the early phase of the disease, hence being the first identifiable signs to propel clinical suspicion. Leprosy predominantly affects the skin and peripheral nerves. The disease has been documented many centuries preceding the biblical era. Over many decades, the classification of Hansen’s disease has changed as modern medical science evolved. Patients with leprosy are usually subjected to discrimination, rejection from society and can suffer from social stigma, poor quality of life (QoL), low self-esteem and permanent disfigurements. Studies have shown that leprosy has a significant negative impact on the patients’ QoL. Leprosy is often not suspected by practicing clinicians because it is no longer emphasised in the medical curricula. In modern years, attention has gradually shifted from leprosy to tuberculosis (TB) and human immunodeficiency virus (HIV).

Historically, vaccine hesitancy (VH) has been a thorn in the side of public health efforts to contain and eradicate infectious diseases. This phenomenon is magnified in light of the current coronavirus disease 2019 (COVID-19) pandemic. Surveys conducted across South Africa since the outbreak of COVID-19 demonstrate the complexity of factors that contribute towards VH in this population. Amidst the negative press that the COVID-19 vaccine has received, especially across social media, understanding and combatting VH remains important to achieve herd immunity. This article aims to shed light on key factors fuelling COVID-19 VH in South Africa and provides a framework from which to address this problem.

People with disabilities, especially those living in low- and middle-income countries, experience significant challenges in accessing healthcare services and support. At times of disasters and emergencies, people with disabilities are further marginalised and excluded. During the coronavirus disease 2019 (COVID-19) pandemic, many people with disabilities are unable to access healthcare facilities, receive therapeutic interventions or rehabilitation, or gain access to medication. Of those who are able to access facilities, many experience challenges, and at times direct discrimination, accessing life-saving treatment such as intensive care unit admission and ventilator support. In addition, research has shown that people with disabilities are at higher risk of contracting the virus because of factors that include the need for interpersonal caregivers and living in residential facilities. We explore some of the challenges that people with disabilities residing in South Africa currently experience in relation to accessing healthcare facilities.

Most cases of hypertension are because of essential hypertension, however 5% - 15% of cases can be a result of a secondary cause. In this article, we focus on the endocrine causes of secondary hypertension with a particular focus on pheochromocytomas (PCCs) and paragangliomas (PGLs). Around 15 endocrine disorders can initially present with hypertension. Amongst those PCCs and PGLs are rare but potentially life-threatening causes. An early diagnosis and timely referral can be life-saving. Herein, we present an approach for screening and diagnosis of these patients and focus on the importance of genetic testing.

Scabies is a parasitic infestation of the skin caused by the mite Sarcoptes scabiei var. hominis . It is common in tropical areas, including the sub-tropical areas of Southern Africa. Predisposing factors are overcrowding, poor personal hygiene, low socio-economic standards and impaired host immunity. Although it can occur at any age, scabies is commonly seen in children and young adults. It is not a fatal disease; however, it can cause severe morbidity and poor quality of life. Scabies can complicate with pyoderma which may result in post-streptococcal glomerulonephritis. There are two clinical variants, classic scabies and the much rarer crusted scabies (Norwegian scabies).

The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on elderly patients, and thus, adequate treatment plans are essential. This qualitative report provides recommendations for the supportive care and treatment of residents in long-term care facilities (LTCF) with COVID-19. A treatment protocol was developed in response to an outbreak of COVID-19 in an LTCF based in Johannesburg and was implemented over a 3-month period.

The essential medicines concept is recognised as an instrument to improve medicines access and to promote cost-effective use of health resources. outh Africa adopted the concept and implemented the Standard Treatment Guidelines and Essential Medicines List (STGs/EML) in 996 when the National Drug Policy for South Africa was launched. The STGs/EML was meant to address the inequities in medicines access and use and to ensure a standard of care to all citizens, yet these inequities still exist. The implementation of the new National Health Insurance (NHI) scheme is envisaged to relieve this healthcare inequity. The STGs/EML still forms the basis of care in the public sector, but a critique of implementing this tool and lessons that can be applied from this implementation for NHI are lacking. This piece addresses these shortfalls and highlights questions surrounding the implementation of the STGs/EML.

International and national guidelines on chronic obstructive pulmonary disease (COPD) emphasise bronchodilators as first-line therapy. However, in considering them the ‘foundation’ of treatment, attention has shifted from the fact that COPD is fundamentally an inflammatory disease. The mainstay ought to be anti-inflammatory medication, and inhaled corticosteroids (ICS) are the best agents we have presently. There was initial scepticism about their role, but ICS were subsequently shown to have numerous anti-inflammatory effects. They are synergistic with bronchodilators at a molecular and clinical level and unequivocally improve dyspnoea, quality of life, exacerbation frequency and, more recently, mortality. These benefits are most apparent in the COPD eosinophilic phenotype. These beneficial effects have been met with some reservations because of the predisposition to pneumonia of ICS. This must be seen in context: over 90% of COPD patients in all clinical trials do not get pneumonia. The fact that patients with COPD are predisposed to pneumonia because of the disease itself is disregarded; this is a crucial omission as this constitutes the baseline incidence of about 3%. When one allows for this, then in the clinical reports, the excess risk of pneumonia ranges from zero to a maximum of 3%. Equally, some of the systemic effects attributed to ICS fail to appreciate that the disease, smoking and older age are risk factors in themselves, and ICS do not aggravate these. Chronic obstructive pulmonary disease has considerable impact on respiratory reserve and is associated with increasing morbidity; optimal outcomes are best achieved with long-acting bronchodilators and ICS co-prescription.

The book – Connected Lives : Families, households, health and care in South Africa (edited by Nolwazi Mkhwanazi and Lenore Manderson) 1 – is about some of the core business of family medicine. In primary healthcare, and family medicine in particular, the context of the person being treated is central. The evolving understanding of social determinants of health and disease, the linkages between biological illness with social, nutritional, environmental and political context are increasingly important. These shifts require health practitioners to practice differently to how many have been trained traditionally, being challenged to be much more explicit in linking clinical care to the context of the person (‘patient’). Yet, it is this context that clinicians often struggle to understand how the family and households are constituted, how it ‘works’ and what the dynamics are.

Practice-based research networks have been an important strategy in many parts of the world to enable primary care research and involve clinicians. The Stellenbosch University Family Physician Research Network (SUFPREN) was established in 2017 to enable family physicians in clinical practice to engage with practical research that addressed key challenges and enhanced clinical governance. It is a collaboration between academic family physicians at the university and clinical family physicians in the district health services. In this article, the establishment of SUFPREN is described – membership of the network, selection of research questions, roles in the research process, communication and coordination, involvement of the Department of Health, types of questions and methods, data management, dissemination of findings and funding. The initial work of SUFPREN is described and a vision for future family physician research networks in South Africa is defined.

Road traffic injuries (RTIs) constitute one of the five major disease burdens in South Africa with high mortality and morbidity. Thus far, the scientific enquiry into this burden has not been accompanied by successful government efforts to meet the challenge. Currently, more than 1.2 million people die and 20–50 million are with disabilities annually country-wide from RTIs. While there is a progressive reduction in mortality related to human immunodeficiency virus (HIV) conditions as a result of interventions, the mortality from RTI is seen to be progressively worsening as a result of increasing motorisation. There are disparities in the burden of RTI across different countries, with low- and middle-income countries bearing the highest burden. In Africa, 24.1 per 100 000 people die annually from RTI compared to 10.3 per 100 000 people in European countries. This opinion article investigates the magnitude, trends and prevention of RTI in South Africa.