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Introduction: Antiretroviral therapy (ART) initiation in infants living with HIV before 12 weeks of age can reduce the risk of mortality by 75%. Point‐of‐care (POC) diagnostic testing is critical for prompt ART initiation; however, despite its availability, rates of ART initiation are still relatively low before 12 weeks of age. This systematic review describes the barriers to ART initiation in infants before 12 weeks of age, despite the availability of POC. Methods: This systematic review used a narrative synthesis methodology. We searched PubMed and Scopus using search strategies that combined terms of multiple variants of the keywords "early infant initiation on antiretroviral therapy," "barriers" and "sub‐Saharan Africa" (initial search 18th January 2023; final search 1st August 2023). We included qualitative, observational and mixed methods studies that reported the influences of early infant initiation on ART. We excluded studies that reported influences on other components of the Prevention of Mother to Child Transmission cascade. Using a deductive approach guided by the updated Consolidated Framework of Implementation Research, we developed descriptive codes and themes around barriers to early infant initiation on ART. We then developed recommendations for interventions for the identified barriers using the action, actor, target and time framework from the codes. Results: Of the 266 abstracts reviewed, 52 full‐text papers were examined, of which 12 papers were included. South Africa had most papers from a single country (n = 3) and the most reported study design was retrospective (n = 6). Delays in ART initiation beyond 12 weeks in infants 0–12 months were primarily associated with health facility and maternal factors. The most prominent barriers identified were inadequate resources for POC testing (including human resources, laboratory facilities and patient follow‐up). Maternal‐related factors, such as limited male involvement and maternal perceptions of treatment and care, were also influential. Discussion: We identified structural barriers to ART initiation at the health system, social and cultural levels. Improvements in the timely allocation of resources for POC testing operations, coupled with interventions addressing social and behavioural barriers among both mothers and healthcare providers, hold a promise for enhancing timely ART initiation in infants. Conclusions: This paper identifies barriers and proposes strategies for timely ART initiation in infants. [ABSTRACT FROM AUTHOR]

It is no longer a myth that climate change‐related disasters are on the rise globally, with severe and devastating consequences in developing countries, particularly in Sub‐Saharan Africa, where many of the world's poor people reside. Thus, the emphasis on adaptation to climate change is no longer a choice or a deferred problem into the future, but rather an urgent matter of concern which must be considered a policy priority. As a response to retrogressive climate change challenges on social‐economic development and environmental degradation, the government of South Africa has in the last two and half decades, embarked on the progressive formulation of different policy instruments and strategic frameworks to curb and minimize the impacts of climate change on all sub‐sectors of the economy. Although much remains to be achieved, some level of success has been realized, particularly in the space of policy formulation, albeit the poor record of implementation. Using research methods inspired by the tradition of qualitative research and an appraisal of existing literature, this paper discusses the complexities of climate change adaptation governance at a local government level in South Africa, focusing on the Eastern Cape Province. It is argued in the paper that one of the major challenges for climate change governance at local municipality levels in South Africa emanates from the gap between aspirations and actions across the entire national governance system. The absence of an integrated climate change governance system has posed significant systemic challenges, and these have tended to constrain decision‐making and implementation processes. These issues have been discussed within the broader discourse of the sustainable development goals, particularly goals number 13, 16 and 17. [ABSTRACT FROM AUTHOR]

The need to swiftly transition to clean energy and expand electricity access is pressing; however, the goals of SDG7 are unlikely to be met by 2030, with the UN specifically mentioning land‐locked states as being off track. Through the conceptual lens of 'leapfrogging' fossil fuels, straight from traditional fuel sources to renewable energy, this paper discusses the relationship between electricity production and independence. It makes a conceptual contribution by introducing the term 'energy independence through leapfrogging', which is used to characterise the process of reducing dependency on another country – in the case of Eswatini, electricity is supplied by South Africa. Drawing from empirical research in Eswatini involving document analysis and in‐depth interviews, this paper discusses the potential for the country to move from being primarily an importer of electricity to generating its own supply from renewable sources. With Eswatini's current electricity supply from South Africa at risk/expiring in 2025, this research argues that the country faces a moment of opportunity for Eswatini to build further generation capacity, with a recommended focus on solar energy. The paper identifies potential challenges/barriers to this energy transition, examining power generation, storage, maintenance and affordability as key areas for intervention. Drawing on previous theories of electricity access, the paper argues that 'access' to electricity requires consideration of the affordability and reliability of energy systems. Eswatini is an understudied geographical area, and this paper makes a contribution to the literature on energy transitions by examining the specific circumstances attending this transition and examining these with relevance for other land‐locked nations in sub‐Saharan Africa. [ABSTRACT FROM AUTHOR]

This paper investigates effects of contagion in sub‐Saharan African stock markets by examining both crisis and non‐crisis contingent theories. Specifically, the paper examines cross‐market linkages through heteroskedasticity bias‐adjusted correlation in asset returns and assesses the impact of regional macroeconomic fundamentals on stock market volatility using GARCH‐MIDAS technique. The crisis contingent results reveal that there is no evidence of contagion in sub‐Saharan African markets from crises in global developed markets (the UK and the US). However, there is evidence of contagion from emerging market crises (China, South Africa, and Kenya). The non‐crisis contingent analysis underscores the significance of regional economic fundamentals, especially inflation and the GDP, on stock market volatility in South Africa, Nigeria, and Kenya. [ABSTRACT FROM AUTHOR]

This paper examines the asymmetric link between carbon pricing and the comparative advantage in environmental goods exports in South Africa from 1995 to 2021. The non‐linear autoregressive distributed lag model is utilized to investigate the effects of both minor and major positive and negative fluctuations in carbon taxes, technological innovation, and energy transition on comparative advantage. The results reveal that carbon taxes have an asymmetric effect on comparative advantage in both the short and long runs, with positive shocks exerting a greater beneficial influence than negative shocks. Specifically, it is found that a 1% reduction in carbon taxes corresponds to a 1.24% decline in the response variable, whereas a 1% increase in carbon taxes is associated with a 2.72% increase in comparative advantage in environmental goods exports, which is twice as large. The study also uncovers evidence of an asymmetric relationship between low‐carbon technological innovation and comparative advantage in environmental goods exports. However, strong evidence of a long‐run asymmetric linkage between the energy transition and comparative advantage is not established. Nevertheless, it is noteworthy that a positive shift in energy transition is linked with a 0.32% rise in comparative advantage in environmental goods exports, whereas a negative shift in energy transition corresponds to a 0.11% decrease. The practical policy implications are also discussed. [ABSTRACT FROM AUTHOR]

Concerns about the human effects of climate change have contributed to forecasts of how populations in drought‐prone and flood‐prone areas would respond to these events. Empirical studies have predicted that human migration has been among the critical resilient strategy in responding to the impact of climate change. To obtain a more comprehensive understanding of the climate–migration relationship, the impacts of climate change on international migration flows from sub‐Saharan Africa nations to South Africa are investigated empirically in this paper. The study employed static and dynamic models and panel data from 35 countries in sub‐Saharan Africa, spanning 1990 to 2017. The findings are as follows: (1) The analysis shows that historical temperature has a positive and statistically significant effect on outmigration in agriculture‐dependent nations. (2) The analysis shows that agricultural value added as a share in gross domestic product has a negative and statistically significant effect on outmigration in agriculture‐dependent nations. (3) The results also show that geographic location and development level of a country, in addition to dependency on agriculture, are key factors in the climate change–international migration nexus. Policy implications are discussed. [ABSTRACT FROM AUTHOR]

New public management (NPM) was introduced in the western world with a sole purpose of reforming the public sector and its approaches in managing affairs of the state. These reforms were later adopted in some parts of the African continent including in the sub‐Saharan Africa trying to emulate the successes of the developed economies of the world. South Africa as one of the countries in Africa also sought to shift from its apartheid bureaucratic, inefficient and rule driven management of public affairs. To this end, the democratic South Africa aligned its constitutional provisions with the principles of NPM which include but are not limited to participatory planning, decentralisation, performance management, effectiveness and efficiency. These principles were introduced precisely to better manage the state and its resources including at the local sphere of government. Local government in South Africa is underpinned by its own sets of policy frameworks. This conceptual paper seeks to evaluate the application of NPM principles in the South African municipalities. The said evaluation was undertaken through a review of existing literature. The paper concludes that the application of the said principles in the South African municipalities is confronted by some challenges including lack of political will, corruption as well as lack of skills and capacities. Necessary recommendations have been developed to enhance the performance of municipalities so as to achieve the otherwise good intended provisions of the NPM. [ABSTRACT FROM AUTHOR]

ABSTRACT This paper provides an analysis of the interplays between climate risks, eco-systems and adaptation decisions using South American and Sub- Saharan African farm surveys. Climate risk indicators such as seasonal Coefficient of Variation in Precipitation ( CVP) and Diurnal Temperature Range ( DTR) are matched with major eco-systems. Adoption decisions of the six natural resource enterprises are modelled using a spatial Logit model. First, this paper finds that climate risks are higher in the grasslands and meadow eco-systems in South America as they are high in the lowland arid zones in Africa. However, climate risks across the continent are, compared with Sub-Saharan Africa, much lower in South America. Second, a higher temperature implies a higher climate risk in Africa, which is not the case in South America owing to the predominant influences of regional weather events such as the ENSO. Third, while the CVP is a dominant risk factor in Africa, the DTR is a dominant risk factor in South America due to the vast ranges of the Andes Mountain. Winter DTR is predicted to fall by 3 °C under both the UKMO and the GISS scenarios by the middle of this century. Altered climate risks will push a large number of farmers to switch away from a crops-only enterprise due to a large decrease in daily temperature variability. Farmers adapt by increasing a crops-livestock enterprise in the grasslands with wood cover and subtropical drought-deciduous forests. This paper provides a coupled analysis of global (climate), local (eco-systems) and individual (adaptation) processes. [ABSTRACT FROM AUTHOR]

Support for the enrolment of adolescents in research has been constrained by uncertainties in parental involvement, and the lack of clarity in the ethical and legal frameworks. We conducted a scoping review to examine articles that explored the opinion of scholars on the question of adolescent consent and conditions for parental waivers in research in sub‐Saharan Africa (SSA). Guided by the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) tool, we searched electronic databases (PubMed, EMBASSE, EBSCOHOST) and also reviewed the references of articles identified for additional relevant literature. We included full text English articles focusing on adolescent consent and parental waivers in SSA that were published between 2004 and 2020. We excluded studies focusing on healthcare, theses, and reviews. We reviewed a total of 21 publications from South Africa (n = 12), Kenya (n = 4) and Botswana, Malawi, Nigeria, Uganda and Zimbabwe (n = 1 each). We identified four broad thematic issues: the current position regarding parental waivers and self‐consent; parental involvement in the consent process; the role of community approval or consent when adolescent self‐consent approaches were used; and complexities and ambiguities in legal requirements and ethical guidelines on adolescent consent. Our findings show inconsistencies and ambiguities in the existing legal and ethical frameworks within and across different countries, and underscore the need for consistent and clearer guidance on parental waivers and adolescent self‐consent. Harmonization of the legal and ethical frameworks taking into account varying contexts is critically important to ensure research on adolescents in SSA meets adolescents' specific unmet needs. [ABSTRACT FROM AUTHOR]

This paper reflects on issues raised by work with children in an ongoing child mobility study in three sub-Saharan African countries: Ghana, Malawi and South Africa. There are now 70 school pupils of varying ages involved in the project, but the paper is particularly concerned with the participation of those children 14 years and under. We examine the significant ethical issues associated with working with younger child researchers, and linked questions concerning the spaces open to them in African contexts where local cultural constructions of childhood and associated economic imperatives (which commonly drive family and household endeavour) help shape the attitudes of adults to children’s rights and responsibilities and inter-generational power relations. [ABSTRACT FROM AUTHOR]

• Only in the last 25 years or so have interest groups in Sub-Sahara Africa become a focus of academic research. This is mainly due to an increasing number of societies becoming more democratic. What earlier research was conducted on interests and interest group activity in the sub-region, heavily favoured a corporatist perspective; but in recent years the emphasis has been on the role of civil society organizations (CSOs) in their relatively more autonomous role from the state. This paper examines the nature of interest group behaviour in Sub-Sahara Africa and, in greater detail, in South Africa, focusing on the relationship between these groups and the state and society. The major premise presented is that democratization in the region since 1994 has weakened the corporatist hold of the state and has strengthened and expanded civil society. • South Africa is used as an example of a developing democracy in which interest group activity has increased as shown by the wide range of CSOs and has produced a unique system combining corporatism and pluralism. Several cases are presented, including the role of traditional authorities, education, women's groups and the interests involved in the HIV/AIDS crisis. [ABSTRACT FROM AUTHOR]

This paper measures the extent to which South African economic growth is an engine of growth in sub-Saharan Africa. Results based on panel data estimation for 47 African countries over four decades suggest that South African growth has a substantial positive impact on growth in the rest of Africa, even after controlling for other growth determinants. The estimates are robust to the effects of global and regional shocks, changes in model specification, and sample period. [ABSTRACT FROM AUTHOR]

Aim: As climate change accelerates, assessing how climate shapes gene flow and neutral and adaptive genetic differentiation on landscapes is increasingly important. Aardvarks (Orycteropus afer) are ecologically important in sub‐Saharan Africa but are sensitive to human pressures and increasing aridity. We used individual, population and landscape genetic approaches to infer the influence of landscape, climate and potential adaptive differences on gene flow. Location: We surveyed 8 protected and 4 privately owned areas in South Africa, 2 protected areas in Eswatini and one location in Kenya during 2016–2018. Methods: We developed microsatellite markers and methods for DNA extraction from faeces, collected and genotyped faecal samples from focal areas and estimated genetic structure. We inferred space use from individual redetections, tested for close relatives and estimated genetic neighbourhood distance. We applied individual‐based landscape genetic analyses at multiple scales to test hypotheses about genetic differentiation by landscape resistance and potential adaptive differences. Results: We developed 19 variable microsatellite loci and collected 253 faecal samples from 13 focal areas. We genotyped 104 samples successfully at ≥8 loci as needed for individual identification. The genetic structure suggested 3 regional divisions in South Africa. We detected individuals at locations ≤7.3 km distant and closely related individuals at ≤44 km; genetic neighbourhood distance was <55 km. Lower precipitation increased landscape resistance and strongly predicted genetic differentiation at most spatial scales. Temperature differences at sampling sites also influenced structure, suggesting climate‐associated adaptive differences. Main Conclusions: The genetic structure of aardvarks is strongly shaped by climate, with arid areas limiting gene flow and reflects apparent isolation by adaptation associated with temperature. Dispersal distances likely are <55 km. The markers we developed will facilitate studies of space use, dispersal, population density or survival. Aridification will increase fragmentation and we recommend monitoring aardvark presence as an indicator of ecosystem change associated with aridification. [ABSTRACT FROM AUTHOR]

Background: Achievement of ISO15189 accreditation demonstrates competency of a laboratory to conduct testing. Three programmes were developed to facilitate achievement of accreditation in low‐ and middle‐income countries: Strengthening Laboratory Management Towards Accreditation (SLMTA), Stepwise Laboratory Improvement Process Towards Accreditation (SLIPTA) and Laboratory Quality Stepwise Implementation (LQSI). Objective: To determine the level of accreditation and associated barriers and facilitators among medical laboratories in the WHO‐AFRO region by 2020. Methods: A desk review of SLIPTA and SLMTA databases was conducted to identify ISO15189‐accredited medical laboratories between January 2013 and December 2020. Data on access to the LQSI tool were extracted from the WHO database. Facility and country characteristics were collected for analysis as possible enablers of accreditation. The chi‐square test was used to analyse differences with level of significance set at <0.05. Results: A total of 668 laboratories achieved accreditation by 2020 representing a 75% increase from the number in 2013. Accredited laboratories were mainly in South Africa (n = 396; 55%) and Kenya (n = 106; 16%), two countries with national accreditation bodies. About 16.9% (n = 113) of the accredited laboratories were registered for the SLIPTA programme and 26.6% (n = 178) for SLMTA. Approximately 58,217 LQSI users were registered by December 2020. Countries with a higher UHC index for access to HIV care and treatment, higher WHO JEE scores for laboratory networks, a larger number of registered LQSI users, with national laboratory policy/strategic plans and PEPFAR‐priority countries were more likely to have an accredited laboratory. Of the 475 laboratories engaged in the SLIPTA programme, 154 attained ≥4 SLIPTA stars (ready to apply for accreditation) and 113 achieved ISO 15189 accreditation, with 96 enrolled into the SLMTA programme. Lower‐tier laboratories were less likely to achieve accreditation than higher‐tier laboratories (7.7% vs. 30%) (p < 0.001). The probability of achieving ISO 15189 accreditation (19%) was highest during the first 24 months after enrolment into the SLIPTA programme. Conclusion: To sustainably anchor quality improvement initiatives at facility level, national approaches including access to a national accreditation authority, adoption of national quality standards and regulatory frameworks are required. [ABSTRACT FROM AUTHOR]

This study focuses on a cohort of adults (40‐plus) in rural South Africa to unpack associations between physical health and receipt of social support, and the extent to which these associations were moderated by marital status. We use logistic regression to estimate the odds of having received emotional, physical, or financial support separately for men (N = 2247) and women (N = 2609). Our results suggest having an Activity of Daily Living (ADL) limitation or having at least one chronic condition was not significantly associated with social support receipt for women, but having an ADL limitation was associated with reduced odds of receiving financial support among men. Although marital status was strongly and significantly associated with receipt of social support for both men and women, marital status moderated the relationship between health indicators and social support receipt only for men. Our findings suggest that when men, but not women, experience a marital dissolution and are suffering from a disability or a chronic condition, their networks respond by providing needed social support. [ABSTRACT FROM AUTHOR]

In some countries of sub‐Saharan Africa, the prevalence of HIV exceeds 20%; in South Africa, 20.4% of people are living with HIV. We examined the impact of HIV infection on the overall survival (OS) of women with nonmetastatic breast cancer (BC) enrolled in the South African Breast Cancer and HIV Outcomes (SABCHO) study. We recruited women with newly diagnosed BC at six public hospitals from 1 July 2015 to 30 June 2019. Among women with stages I‐III BC, we compared those with and without HIV infection on sociodemographic, clinical, and treatment factors. We analyzed the impact of HIV on OS using multivariable Cox proportional hazard models. Of 2367 women with stages I‐III BC, 499 (21.1%) had HIV and 1868 (78.9%) did not. With a median follow‐up of 29 months, 2‐year OS was poorer among women living with HIV (WLWH) than among HIV‐uninfected women (72.4% vs 80.1%, P <.001; adjusted hazard ratio (aHR) 1.49, 95% confidence interval (CI) = 1.22‐1.83). This finding was consistent across age groups ≥45 years and <45 years, stage I‐II BC and stage III BC, and ER/PR status (all P <.03). Both WLWH with <50 viral load copies/mL and WLWH with ≥50 viral load copies/mL had poorer survival than HIV‐uninfected BC patients [aHR: 1.35 (1.09‐1.66) and 1.54 (1.20‐2.00), respectively], as did WLWH who had ≥200 CD4+ cells/mL at diagnosis [aHR: 1.39 (1.15‐1.67)]. Because receipt of antiretroviral therapy has become widespread, WLWH is surviving long enough to develop BC; more research is needed on the causes of their poor survival. [ABSTRACT FROM AUTHOR]

Warfarin remains the most widely prescribed oral anticoagulant in sub‐Saharan Africa. However, because of its narrow therapeutic index, dosing can be challenging. We have therefore (a) evaluated and compared the performance of 21 machine‐learning techniques in predicting stable warfarin dose in sub‐Saharan Black‐African patients and (b) externally validated a previously developed Warfarin Anticoagulation in Patients in Sub‐Saharan Africa (War‐PATH) clinical dose–initiation algorithm. The development cohort included 364 patients recruited from eight outpatient clinics and hospital departments in Uganda and South Africa (June 2018–July 2019). Validation was conducted using an external validation cohort (270 patients recruited from August 2019 to March 2020 in 12 outpatient clinics and hospital departments). Based on the mean absolute error (MAE; mean of absolute differences between the actual and predicted doses), random forest regression (12.07 mg/week; 95% confidence interval [CI], 10.39–13.76) was the best performing machine‐learning technique in the external validation cohort, whereas the worst performing technique was model trees (17.59 mg/week; 95% CI, 15.75–19.43). By comparison, the simple, commonly used regression technique (ordinary least squares) performed similarly to more complex supervised machine‐learning techniques and achieved an MAE of 13.01 mg/week (95% CI, 11.45–14.58). In summary, we have demonstrated that simpler regression techniques perform similarly to more complex supervised machine‐learning techniques. We have also externally validated our previously developed clinical dose–initiation algorithm, which is being prospectively tested for clinical utility. [ABSTRACT FROM AUTHOR]

Production of maize, Zea mays L. (Poaceae), in sub‐Saharan Africa is threatened by a new invasive pest, fall armyworm (FAW), Spodoptera frugiperda (JE Smith) (Lepidoptera: Noctuidae). To mitigate this threat, push–pull companion cropping, a system originally developed for management of lepidopteran stemborers, may be used to control FAW. The original system involved trap crops that functioned as a 'pull' component to attract moths away from the main crop. How grass species can be used as trap crops in a push–pull system to control FAW is a question that remains to be answered, because maize is already a highly preferred host plant. Therefore, we tested oviposition preference of FAW female moths in no‐choice and two‐choice experiments and larval performance on six selected grasses (Poaceae) to assess their roles as trap crop 'pull' plants in the system. In no‐choice tests, numbers of eggs deposited on Brachiaria brizantha (Hochst. ex A. Rich.) R. Webster cv. 'Piata', cv. 'Mulato II', and cv. 'Xaraes', and Napier grass (Pennisetum purpureum K. Schumach) cv. 'South Africa' were not statistically different from those deposited on maize. In two‐choice tests between grasses and maize, there were no significant differences in number of eggs laid when the plants were of the same size. However, in two‐choice tests with maize plants half of the size of the grasses, significantly more eggs were laid on B. brizantha cv. Xaraes and P. purpureum cv. South Africa than on maize, suggesting that crop phenology could make a difference. Numbers of larvae arrested on grass leaf cuts were considerably lower than those on maize leaf cuts after 48 h. In two‐choice tests with maize, molasses grass (Melinis minutiflora P. Beauv.) was the only grass that was significantly preferred to maize for larval settlement after 24 h. After 48 h in the two‐choice test, it was the only grass that retained larvae, although the larval count was significantly lower than on maize. Our data show that none of the grasses tested were strongly preferred to maize, but the results indicate plants attractive to FAW adults and larvae that could be utilized in a multiple trap crop approach to target various stages of the pest. Furthermore, results indicate the importance of planting these companion plants earlier than maize. [ABSTRACT FROM AUTHOR]

Introduction: Few interventions have demonstrated improved retention in care for people living with HIV (PLHIV) in sub‐Saharan Africa. We tested the efficacy of two personal support interventions – one using text messaging (SMS‐only) and the second pairing SMS with peer navigation (SMS+PN) – to improve HIV care retention over one year. Methods: In a cluster randomized control trial (NCT# 02417233) in North West Province, South Africa, we randomized 17 government clinics to three conditions: SMS‐only (6), SMS+PN (7) or standard of care (SOC; 4). Participants at SMS‐only clinics received appointment reminders, biweekly healthy living messages and twice monthly SMS check‐ins. Participants at SMS+PN clinics received SMS appointment reminders and healthy living messages and spoke at least twice monthly with peer navigators (PLHIV receiving care) to address barriers to care. Outcomes were collected through biweekly clinical record extraction and surveys at baseline, six and 12 months. Retention in HIV care over one year was defined as clinic visits every three months for participants on antiretroviral therapy (ART) and CD4 screening every six months for pre‐ART participants. We used generalized estimating equations, adjusting for clustering by clinic, to test for differences across conditions. Results: Between October 2014 and April 2015, we enrolled 752 adult clients recently diagnosed with HIV (SOC: 167; SMS‐only: 289; SMS+PN: 296). Individuals in the SMS+PN arm had approximately two more clinic visits over a year than those in other arms (p < 0.01) and were more likely to be retained in care over one year than those in SOC clinics (54% vs. 38%; OR: 1.77, CI: 1.02, 3.10). Differences between SMS+PN and SOC conditions remained significant when restricting analyses to the 628 participants on ART (61% vs. 45% retained; OR: 1.78, CI: 1.08, 2.93). The SMS‐only intervention did not improve retention relative to SOC (40% vs. 38%, OR: 1.12, CI: 0.63, 1.98). Conclusions: A combination of SMS appointment reminders with personalized, peer‐delivered support proved effective at enhancing retention in HIV care over one year. While some clients may only require appointment reminders, the SMS+PN approach offers increased flexibility and tailored, one‐on‐one support for patients struggling with more substantive challenges. [ABSTRACT FROM AUTHOR]

Introduction: The HIV care cascade examines the attrition of people living with HIV from diagnosis to the use of antiretroviral therapy (ART) and suppression of viral replication. We reviewed the literature from sub‐Saharan Africa to assess the definitions used for the different steps in the HIV care cascade. Methods: We searched PubMed, Embase and CINAHL for articles published from January 2004 to December 2020. Longitudinal and cross‐sectional studies were included if they reported on at least one step of the UNAIDS 90‐90‐90 cascade or two steps of an extended 7‐step cascade. A step was clearly defined if authors reported definitions for numerator and denominator, including the description of the eligible population and methods of assessment or measurement. The review protocol has been published and registered in Prospero. Results and discussion: Overall, 3364 articles were screened, and 82 studies from 19 countries met the inclusion criteria. Most studies were from Southern (38 studies, 34 from South Africa) and East Africa (29 studies). Fifty‐eight studies (71.6%) were longitudinal, with a median follow‐up of three years. The medium number of steps covered out of 7 steps was 3 (interquartile range [IQR] 2 to 4); the median year of publication was 2015 (IQR 2013 to 2019). The number of different definitions for the numerators ranged from four definitions (for step "People living with HIV") to 21 (step "Viral suppression"). For the denominators, it ranged from three definitions ("Diagnosed and aware of HIV status") to 14 ("Viral suppression"). Only 12 studies assessed all three of the 90‐90‐90 steps. Most studies used longitudinal data, but denominator–denominator or denominator–numerator linkages over several steps were rare. Also, cascade data are lacking for many countries. Our review covers the academic literature but did not consider other data, such as government reports on the HIV care cascade. Also, it did not examine disengagement and reengagement in care. Conclusions: The proportions of patients retained at each step of the HIV care cascade cannot be compared between studies, countries and time periods, nor meta‐analysed, due to the many different definitions used for numerators and denominators. There is a need for standardization of methods and definitions. [ABSTRACT FROM AUTHOR]

Warfarin remains the oral anticoagulant of choice in sub‐Saharan Africa. However, dosing is challenging due to a highly variable clinical response for a given dose. This study aimed to develop and validate a clinical warfarin dose‐initiation model in sub‐Saharan Black‐African patients. For the development cohort, we used data from 364 patients who were recruited from 8 outpatient clinics and hospital departments in Uganda and South Africa (June 2018–July 2019). Validation was undertaken using the International Warfarin Pharmacogenetics Consortium (IWPC) dataset (690 black patients). Four predictors (age, weight, target International Normalized Ratio range, and HIV status) were included in the final model, which achieved mean absolute errors (MAEs; mean of absolute differences between true dose and dose predicted by the model) of 11.6 (95% confidence interval (CI) 10.4–12.8) and 12.5 (95% CI 11.6–13.4) mg/week in the development and validation cohorts, respectively. Two other clinical models, IWPC and Gage, respectively, obtained MAEs of 12.5 (95% CI 11.3–13.7) and 12.7 (95% CI 11.5–13.8) mg/week in the development cohort, and 12.1 (95% CI 11.2–13.0) and 12.2 (95% CI 11.4–13.1) mg/week in the validation cohort. Compared with fixed dose‐initiation, our model decreased the percentage of patients at high risk of suboptimal anticoagulation by 7.5% (1.5–13.7%) and 11.9% (7.1–16.8%) in the development and validation cohorts, respectively. The clinical utility of this model will be tested in a prospective study. Study HighlightsWHAT IS THE CURRENT KNOWLEDGE ON THE TOPIC?☑ Warfarin dosing remains challenging due to a highly variable clinical response for a given dose. WHAT QUESTION DID THIS STUDY ADDRESS?☑ Can a clinical dose‐initiation model be developed and validated for sub‐Saharan Black‐African patients? WHAT DOES THIS STUDY ADD TO OUR KNOWLEDGE?☑ We have developed the first warfarin dose‐initiation clinical model for Black‐African patients in Uganda and South Africa. HOW MIGHT THIS CHANGE CLINICAL PHARMACOLOGY OR TRANSLATIONAL SCIENCE?☑ We will be implementing and validating this model in a prospective cohort to inform future large‐scale implementation. More optimized dosing should improve the quality of warfarin anticoagulation in these two developing countries. [ABSTRACT FROM AUTHOR]

Female‐initiated HIV prevention methods, such as oral pre‐exposure prophylaxis (PrEP) and the vaginal ring, may be important risk reduction strategies for breastfeeding women. Given their novelty, information about the sociocultural context and how it influences perceptions of and support for their use during breastfeeding is lacking. To address this gap, we conducted 23 focus group discussions separately with pregnant and breastfeeding women, male partners and grandmothers (N = 196) and 36 in‐depth interviews with key informants in Malawi, South Africa, Uganda and Zimbabwe. We analysed the data using a framework analysis method. Overall, breastfeeding was the norm, and participants described the transference of health (e.g., nutrition) and disease (e.g., HIV) to children through breast milk. Participants considered the early breastfeeding period as one of high HIV transmission risk for women. They explained that male partners tend to seek outside sexual partners during this period because women need time to recover from delivery, women focus their attention on the child, and some men are disgusted by breast milk. Participants highlighted concerns about the drugs in oral PrEP transferring to the child through breast milk, but fewer worried about the effects of the vaginal ring because the drug is localized. Women, grandmothers and key informants were supportive of women using these HIV prevention methods during breastfeeding, while male partners had mixed opinions. These findings can be used to tailor messages for promoting the use of PrEP or the vaginal ring during breastfeeding in sub‐Saharan Africa. [ABSTRACT FROM AUTHOR]

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HIV/AIDS‐related (HAR) stigma is still a prevalent problem in Sub‐Saharan Africa, and has been found to be related to mental health of HIV‐positive individuals. However, no studies in the Sub‐Saharan African context have yet examined the relationship between HAR stigma and mental health among HIV‐negative, HIV‐affected adults and families; nor have any studies in this context yet examined stigma as an ecological construct predicting mental health outcomes through supra‐individual (setting level) and individual levels of influence. Multilevel modeling was used to examine multilevel, ecological relationships between HAR stigma and mental health among child and caregiver pairs from a systematic, community‐representative sample of 508 HIV‐affected households nested within 24 communities in KwaZulu‐Natal, South Africa. Two distinct dimensions of HAR stigma were measured: individual stigmatizing attitudes, and perceptions of community normative stigma. Findings suggest that individual‐level HAR stigma significantly predicts individual mental health (depression and anxiety) among HIV‐affected adults; and that community‐level HAR stigma significantly predicts both individual‐level mental health outcomes (anxiety) among HIV‐affected adults, and mental health outcomes (PTSD and externalizing behavior scores) among HIV‐affected children. Differentiated patterns of relationships were found using the two different stigma measures. These findings of unique relationships identified when utilizing two conceptually distinct stigma measures, at two levels of analysis (individual and community) suggest that HAR stigma in this context should be conceptualized as a multilevel, multidimensional construct. These findings have important implications both for mental health interventions and for interventions to reduce HAR stigma in this context. Highlights: First to test if HIV‐related stigma predicts mental health among HIV‐affected (HIV‐) adults/childrenFirst to test whether supra‐individual (setting‐level) stigma predicts mental health in South AfricaFinds that community‐level HIV‐related stigma predicts individual‐level mental health outcomesFinds different pattern relationships using two measures capturing distinct dimensions of HIV stigmaFindings suggest HIV stigma should be conceptualized as a multilevel, multidimensional construct. [ABSTRACT FROM AUTHOR]

Cross-border insolvency literature has developed significantly in recent years. However, the scholarship that has evolved lacks an insight from the perspective of Sub-Saharan Africa (SSA). Existing theories on cross-border insolvencies, and the global insolvency benchmarks that emerged in the recent years, have almost exclusively been developed from the best practices obtained in advanced economies. Accordingly, the context within which SSA cross-border insolvency reform may be undertaken must be determined and explored given the pressure towards globalisation and the potential for the pressure to result in unsuitable legislative reform. This article sets out the context for cross-border insolvency law reform in SSA. It raises issues that are likely to arise during the reform process and challenges that may be faced. Copyright © 2014 INSOL International and John Wiley & Sons, Ltd [ABSTRACT FROM AUTHOR]

Background In Sub-Saharan Africa, children commonly present with severe acute malnutrition ( SAM) complicated by HIV/ AIDS. In 2005, the South African Department of Health implemented the World Health Organization ( WHO) Ten Step programme for the inpatient treatment of SAM. Dietary management with F75 and F100 (where the terms F75 and F100 refer to a mixture of milk, sugar, oil and a vitamin and mineral mix) may not be appropriate for relatively well resourced settings such as South Africa. Methods A structured questionnaire aiming to determine current clinical practice was e-mailed to all dietitians working in hospitals ( n = 53) in KwaZulu-Natal who routinely treated SAM. Results When initially refeeding with no diarrhoea ( ND), F75 was used exclusively by 16% of dietitians to treat infants, and by 42% of dietitians to treat children. If diarrhoea, 16% of dietitians used F75 to treat infants/children. Acidified infant formula ( IF) was given if ND and lactose-free IF was given if diarrhoea. Children were often started on a lactose-free F100 equivalent omitting cautious refeeding. Some gave reduced amounts for cautious refeeding; however, the feeds osmolality was too high. The use of partially hydrolysed feeds increased if the child/infant presented with diarrhoea and/or hypoalbuminea. In the post-initial feeding phase, approximately 14% of dietitians used F100 to treat infants/children. Most gave F100 equivalents as high-energy infant/paediatric formulas. Conclusions The dietetic practices for infants with SAM followed current expert opinion closely rather than the WHO protocol. The omission of cautious refeeding follows neither current expert opinion, nor the WHO protocol, and may predispose to the refeeding syndrome. Limited evidence indicates that partially hydrolysed formulas are less effective than low lactose low osmolality feeds in the treatment of SAM. [ABSTRACT FROM AUTHOR]

The article reflects on the moral theory of the "ubuntu" in Africa. Ubuntu is a word used by the Zulu people of South Africa which more or less means humanness. The author discusses his search for a theory of rightness that reflects the values derived from the cognate terms of ubuntu and the bantu- speaking sub-Saharan Africans. He also identifies six distinct theories that also exist in the literature of the African morality, such as Kantian, Utilitarian and moderate communitarianism. He suggests that developing a competitive moral theory of Africans requires the comprehension of ubuntu in terms of creating harmonious relationships and to avoid conflicting relationships.

Introduction: Integrating standardized measures of HIV stigma and discrimination into research studies of emerging HIV prevention approaches could enhance uptake and retention of these approaches, and care and treatment for people living with HIV (PLHIV), by informing stigma mitigation strategies. We sought to develop a succinct set of measures to capture key domains of stigma for use in research on HIV prevention technologies. Methods: From 2013 to 2015, we collected baseline data on HIV stigma from three populations (PLHIV (N = 4053), community members (N = 5782) and health workers (N = 1560)) in 21 study communities in South Africa and Zambia participating in the HPTN 071 (PopART) cluster‐randomized trial. Forty questions were adapted from a harmonized set of measures developed in a consultative, global process. Informed by theory and factor analysis, we developed seven scales, with values ranging from 0 to 3, based on a 4‐point agreement Likert, and calculated means to assess different aspects of stigma. Higher means reflected more stigma. We developed two measures capturing percentages of PLHIV who reported experiencing any stigma in communities or healthcare settings in the past 12 months. We validated our measures by examining reliability using Cronbach's alpha and comparing the distribution of responses across characteristics previously associated with HIV stigma. Results: Thirty‐five questions ultimately contributed to seven scales and two experience measures. All scales demonstrated acceptable to very good internal consistency. Among PLHIV, a scale captured internalized stigma, and experience measures demonstrated that 22.0% of PLHIV experienced stigma in the community and 7.1% in healthcare settings. Three scales for community members assessed fear and judgement, perceived stigma in the community and perceived stigma in healthcare settings. Similarly, health worker scales assessed fear and judgement, perceived stigma in the community and perceived co‐worker stigma in healthcare settings. A higher proportion of community members and health workers reported perceived stigma than the proportion of PLHIV who reported experiences of stigma. Conclusions: We developed novel, valid measures that allowed for triangulation of HIV stigma across three populations in a large‐scale study. Such comparisons will illuminate how stigma influences and is influenced by programmatic changes to HIV service delivery over time. [ABSTRACT FROM AUTHOR]

Introduction: Adolescent girls are at high risk of HIV infection in sub‐Saharan Africa. Mental health distress, driven by adverse childhood experiences (ACEs) such as abuse, poverty and family HIV, may be an important driver of HIV risk behaviour among adolescent girls, while education may mitigate these risks. This study aimed to develop an empirically based theoretical model between ACEs, mental health distress and HIV risk behaviour among adolescent girls in South Africa and to investigate the potential moderating effects of free schooling provision. Methods: Self‐report questionnaires using validated scales were completed by adolescent girls aged 12 to 17 at baseline in two provinces in South Africa in 2011, with a 99% one‐year follow‐up in 2012 (n = 1498). Sampling included every household in randomly selected census enumeration areas of four deprived health districts. Confirmatory factor analysis was employed to identify measurement models and a structural equation model was developed to test pathways of risk and protection. Results: Internalizing and externalizing mental health distress fully mediated the positive relationship between ACEs at baseline and HIV risk behaviour at follow‐up among adolescent girls. Internalizing mental health distress was associated with increased sexual risk at follow‐up via higher externalizing problems. Free schooling provision at baseline and follow‐up eliminated the pathway from internalizing to externalizing mental health distress by moderating the pathway between ACEs and internalizing mental health distress. It also weakened the pathway from externalizing mental health distress to HIV risk behaviour at follow‐up through a direct negative effect on externalizing mental health distress. Conclusions: Reducing ACEs and adolescent mental health distress is essential for reducing HIV risk behaviour among girls in South Africa. Free schooling provision may be an important tool for reducing these problems and mitigating negative pathways to HIV risk among vulnerable adolescent girls. [ABSTRACT FROM AUTHOR]