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2. Prefrontal coding of learned and inferred knowledge during REM and NREM sleep

Author

Kareem Abdou, Masanori Nomoto, Mohamed H. Aly, Ahmed Z. Ibrahim, Kiriko Choko, Reiko Okubo-Suzuki, Shin-ichi Muramatsu, and Kaoru Inokuchi

Subjects
Science
Abstract

Abstract Idling brain activity has been proposed to facilitate inference, insight, and innovative problem-solving. However, it remains unclear how and when the idling brain can create novel ideas. Here, we show that cortical offline activity is both necessary and sufficient for building unlearned inferential knowledge from previously acquired information. In a transitive inference paradigm, male C57BL/6J mice gained the inference 1 day after, but not shortly after, complete training. Inhibiting the neuronal computations in the anterior cingulate cortex (ACC) during post-learning either non-rapid eye movement (NREM) or rapid eye movement (REM) sleep, but not wakefulness, disrupted the inference without affecting the learned knowledge. In vivo Ca2+ imaging suggests that NREM sleep organizes the scattered learned knowledge in a complete hierarchy, while REM sleep computes the inferential information from the organized hierarchy. Furthermore, after insufficient learning, artificial activation of medial entorhinal cortex-ACC dialog during only REM sleep created inferential knowledge. Collectively, our study provides a mechanistic insight on NREM and REM coordination in weaving inferential knowledge, thus highlighting the power of idling brain in cognitive flexibility.

Published
2024
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3. Accuracy of and preferences for blood-based versus oral-fluid-based HIV self-testing in Malawi: a cross-sectional study

Author

Ailva O’Reilly, Webster Mavhu, Melissa Neuman, Moses K. Kumwenda, Cheryl C. Johnson, George Sinjani, Pitchaya Indravudh, Augustin Choko, Karin Hatzold, and Elizabeth L. Corbett

Subjects
HIV, Self-testing, Cross-sectional study, Malawi, Sub-Saharan Africa, Men, Infectious and parasitic diseases, RC109-216
Abstract

Abstract Background HIV self-testing (HIVST) can use either oral-fluid or blood-based tests. Studies have shown strong preferences for self-testing compared to facility-based services. Despite availability of low-cost blood-based HIVST options, to date, HIVST implementation in sub-Saharan Africa has largely been oral-fluid-based. We investigated whether users preferred blood-based (i.e. using blood sample derived from a finger prick) or oral fluid-based HIVST in rural and urban Malawi. Methods At clinics providing HIV testing services (n = 2 urban; n = 2 rural), participants completed a semi-structured questionnaire capturing sociodemographic data before choosing to test using oral-fluid-based HVST, blood-based HIVST or provider-delivered testing. They also completed a self-administered questionnaire afterwards, followed by a confirmatory test using the national algorithm then appropriate referral. We used simple and multivariable logistic regression to identify factors associated with preference for oral-fluid or blood-based HIVST. Results July to October 2018, N = 691 participants enrolled in this study. Given the choice, 98.4% (680/691) selected HIVST over provider-delivered testing. Of 680 opting for HIVST, 416 (61.2%) chose oral-fluid-based HIVST, 264 (38.8%) chose blood-based HIVST and 99.1% (674/680) reported their results appropriately. Self-testers who opted for blood-based HIVST were more likely to be male (50.3% men vs. 29.6% women, p

Published
2024
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4. Strategies to improve antiretroviral therapy (ART) initiation and early engagement among men in sub-Saharan Africa: A scoping review of interventions in the era of universal treatment

Author

Dovel, Kathryn, Hariprasad, Santhi, Hubbard, Julie Anne, Cornell, Morna, Phiri, Khumbo, Choko, Augustine, Abbott, Rachel, Hoffman, Risa M, Nichols, Brooke, Gupta, Sundeep, and Long, Lawrence

Abstract

ObjectivesMen in sub-Saharan Africa (SSA) have lower rates of antiretroviral therapy (ART) initiation and higher rates of early default than women. Little is known about effective interventions to improve men's outcomes. We conducted a scoping review of interventions aimed to increase ART initiation and/or early retention among men in SSA since universal treatment policies were implemented.MethodsThree databases, HIV conference databases and grey literature were searched for studies published between January 2016 to May 2021 that reported on initiation and/or early retention among men. Eligibility criteria included: participants in SSA, data collected after universal treatment policies were implemented (2016–2021), quantitative data on ART initiation and/or early retention for males, general male population (not exclusively focused on key populations), intervention study (report outcomes for at least one non-standard service delivery strategy), and written in English.ResultsOf the 4351 sources retrieved, 15 (reporting on 16 interventions) met inclusion criteria. Of the 16 interventions, only two (2/16, 13%) exclusively focused on men. Five (5/16, 31%) were randomised control trials (RCT), one (1/16, 6%) was a retrospective cohort study, and 10 (10/16, 63%) did not have comparison groups. Thirteen (13/16, 81%) interventions measured ART initiation and six (6/16, 37%) measured early retention. Outcome definitions and time frames varied greatly, with seven (7/16, 44%) not specifying time frames at all. Five types of interventions were represented: optimising ART services at health facilities, community-based ART services, outreach support (such as reminders and facility escort), counselling and/or peer support, and conditional incentives. Across all intervention types, ART initiation rates ranged from 27% to 97% and early retention from 47% to 95%.ConclusionsDespite years of data of men's suboptimal ART outcomes, there is little high-quality evidence on interventions to increase men's ART initiation or early retention in SSA. Additional randomised or quasi-experimental studies are urgently needed.

Published
2023

5. Correlates of prior HIV testing and schistosomiasis treatment: Baseline survey findings from the creating demand for fishermens schistosomiasis HIV services (FISH) cluster-randomized trial in Mangochi, Malawi.

Author

Kangogo, Geoffrey, Conserve, Donaldson, Kayuni, Sekeleghe, Kumwenda, Moses, Dovel, Kathryn, Chirombo, James, MacPherson, Peter, Corbett, Elizabeth, Butterworth, Anthony, and Choko, Augustine

Subjects
Humans, Praziquantel, Malawi, Schistosomiasis, HIV Infections, HIV Testing, Surveys and Questionnaires
Abstract

BACKGROUND: Fishing exposes fishermen to schistosomiasis-infested fresh water and concurrently through precarious livelihoods to risky sexual behaviour, rendering these two infections occupational hazards for fishermen. This study aimed to characterize the knowledge of the two conditions to obtain necessary data for a subsequent cluster randomized trial designed to investigate demand creation strategies for joint HIV-schistosomiasis service provision in fishing villages on the shores of southern Lake Malawi. METHODS: Enumeration of all resident fishermen in 45 clusters (fishing communities) was carried out between November 2019 and February 2020. In a baseline survey, fishermen reported their knowledge, attitudes and practices in the uptake of HIV and schistosomiasis services. Knowledge of HIV status and previous receipt of praziquantel were modelled using random effects binomial regression, accounting for clustering. Prevalence of willingness to attend a beach clinic was computed. RESULTS: A total of 6,297 fishermen were surveyed from the 45 clusters with harmonic mean number of fishermen per cluster of 112 (95% CI: 97; 134). The mean age was 31.7y (SD: 11.9) and nearly 40% (2,474/6,297) could not read or write. Overall, 1,334/6,293 (21.2%) had never tested for HIV, with 64.4% (3,191/4,956) having tested in the last 12 months, and 5.9% (373/6290) taking antiretroviral therapy (ART). In adjusted analyses, being able to read and write (adjusted risk ratio [aRR: 1.91, 95% CI: 1.59-2.29, p

Published
2023

6. Investigating the effectiveness of web‐based HIV self‐test distribution and linkage to HIV treatment and PrEP among groups at elevated risk of HIV in Viet Nam provinces: a mixed‐methods analysis of implementation from pilot to scale‐up

Author

Van Thi Thuy Nguyen, Yasmin Dunkley, Vo Hai Son, Augustine T. Choko, Phan Thi Thu Huong, Pham Duc Manh, Truong Minh Truong, Huynh Minh Truc, Dap Thanh Giang, Le Thanh Tung, Van Dinh Hoa, Rachel Baggaley, and Cheryl Johnson

Subjects
HIV, key populations, online distribution, self‐testing, Viet Nam, virtual intervention, Immunologic diseases. Allergy, RC581-607
Abstract

Abstract Introduction In Viet Nam, key populations (KPs) face barriers accessing HIV services. Virtual platforms can be leveraged to increase access for KPs, including for HIV self‐testing (HIVST). This study compares reach and effectiveness of a web‐based HIVST intervention from pilot to scale‐up in Viet Nam. Methods A mixed‐methods explanatory sequential design used cross‐sectional and thematic analysis. The pilot launched in Can Tho in November 2020, followed by Hanoi and Nghe An in April 2021. Scale‐up included Can Tho and Nghe An, with 21 novel provinces from April to December 2022. After risk assessment, participants registered on the website, receiving HIVST (OraQuick®) by courier, peer educator or self‐pick‐up. Test result reporting and completing satisfaction surveys were encouraged. Intervention reach was measured through numbers accessing the testing, disaggregated by demographics, and proportion of individuals reporting self‐testing post‐registration. Effectiveness was measured through numbers reporting self‐test results, testing positive and linking to care, and testing negative and using HIVST to manage pre‐exposure prophylaxis (PrEP) use. Thematic content analysis of free‐text responses from the satisfaction survey synthesized quantitative outcomes. Results In total, 17,589 participants registered on the HIVST website; 11,332 individuals ordered 13,334 tests. Participants were generally young, aged

Published
2024
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8. Engaging men through HIV self-testing with differentiated care to improve ART initiation and viral suppression among men in Malawi (ENGAGE): A study protocol for a randomized control trial

Author

Choko, Augustine, Coates, Thomas J, Mphande, Misheck, Balakasi, Kelvin, Robson, Isabella, Phiri, Khumbo, Phiri, Sam, Kulich, Michal, Sweat, Michael, Cornell, Morna, Hoffman, Risa M, and Dovel, Kathryn

Abstract

BackgroundMen experience twice the mortality of women while on ART in sub-Saharan Africa (SSA) largely due to late HIV diagnosis and poor retention. Here we propose to conduct an individually randomized control trial (RCT) to investigate the impact of three-month home-based ART (hbART) on viral suppression among men who were not engaged in care.Methods and designA programmatic, individually randomized non-blinded, non-inferiority-controlled trial design (ClinicalTrials.org NCT04858243). Through medical chart reviews we will identify “non-engaged” men living with HIV, ≥15years of age who are not currently engaged in ART care, including (1) men who have tested HIV-positive and have not initiated ART within 7 days; (2) men who have initiated ART but are at risk of immediate default; and (3) men who have defaulted from ART. With 1:1 computer block randomization to either hbART or facility-based ART (fbART) arms, we will recruit men from 10–15 high-burden health facilities in central and southern Malawi. The hbART intervention will consist of 3 home-visits in a 3-month period by a certified male study nurse ART provider. In the fbART arm, male participants will be offered counselling at male participant’s home, or a nearby location that is preferred by participants, followed with an escort to the local health facility and facility navigation. The primary outcome is the proportion of men who are virally suppressed at 6-months after ART initiation. Assuming primary outcome achievement of 24.0% and 33.6% in the two arms, 350 men per arm will provide 80% power to detect the stated difference.DiscussionIdentifying effective ART strategies that are convenient and accessible for men in SSA is a priority in the HIV world. Men may not (re-)engage in facility-based care due to a myriad of barriers. Two previous trials investigated the impact of hbART on viral suppression in the general population whereas this trial focuses on men. Additionally, this trial involves a longer duration of hbART i.e., three months compared to two weeks allowing men more time to overcome the initial psychological denial of taking ART.

Published
2023

10. Multimorbidity-associated emergency hospital admissions: a 'screen and link' strategy to improve outcomes for high-risk patients in sub-Saharan Africa: a prospective multicentre cohort study protocol [version 2; peer review: 1 approved, 2 approved with reservations]

Author

Charity Salima, Francis Sakita, Ibrahim Simiyu, Hendry Sawe, Sarah Urasa, Miriam Taegtmeyer, Nateiya M. Yongolo, Sarah White, Ben Morton, Jamie Rylance, Felix Limbani, Eve Worrall, Stephen A. Spencer, Gimbo Hyuha, Alice Rutta, Augustine Choko, Gift Treighcy Banda, Julian T. Hertz, Paul Dark, Juma Mfinanga, Blandina T. Mmbaga, Adamson Muula, Rhona Mijumbi, Laura Rosu, Mulinda Nyirenda, Sangwani Salimu, and Matthew Rubach

Subjects
Multimorbidity, non-communicable diseases, hospital care, sub-Saharan Africa, health related quality of life, patient costs, eng, Medicine
Abstract

Background The prevalence of multimorbidity (the presence of two or more chronic health conditions) is rapidly increasing in sub–Saharan Africa. Hospital care pathways that focus on single presenting complaints do not address this pressing problem. This has the potential to precipitate frequent hospital readmissions, increase health system and out-of-pocket expenses, and may lead to premature disability and death. We aim to present a description of inpatient multimorbidity in a multicentre prospective cohort study in Malawi and Tanzania. Primary objectives Determine prevalence of multimorbid disease among adult medical admissions and measure patient outcomes. Health Economic: Measure economic costs incurred and changes in health-related quality of life (HRQoL) at 90 days post-admission. Situation analysis: Qualitatively describe pathways of patients with multimorbidity through the health system. Secondary objectives Determine hospital readmission free survival and markers of disease control 90 days after admission. Health Economic: Present economic costs from patient and health system perspective, sub-analyse costs and HRQoL according to presence of different diseases. Situation analysis: Understand health literacy related to their own diseases and experience of care for patients with multimorbidity and their caregivers. Methods This is a prospective longitudinal cohort study of adult (≥18 years) acute medical hospital admissions with nested health economic and situation analysis in four hospitals: 1) Queen Elizabeth Central Hospital, Blantyre, Malawi; 2) Chiradzulu District Hospital, Malawi; 3) Hai District Hospital, Boma Ng’ombe, Tanzania; 4) Muhimbili National Hospital, Dar-es-Salaam, Tanzania. Follow-up duration will be 90 days from hospital admission. We will use consecutive recruitment within 24 hours of emergency presentation and stratified recruitment across four sites. We will use point-of-care tests to refine estimates of disease pathology. We will conduct qualitative interviews with patients, caregivers, healthcare providers and policymakers; focus group discussions with patients and caregivers, and observations of hospital care pathways.

Published
2024
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12. Effects of daily teriparatide, weekly high-dose teriparatide, or bisphosphonate on cortical and trabecular bone of vertebra and proximal femur in postmenopausal women with fragility fracture: Sub-analysis by quantitative computed tomography from the TERABIT study

Author

Takahashi, Ryosuke, Chiba, Ko, Okazaki, Narihiro, Era, Makoto, Yokota, Kazuaki, Yabe, Yoshihiro, Kondo, Choko, Fukuda, Toru, Fukushima, Kaisho, Kono, Mika, Michikoshi, Yasue, Yamada, Shuta, Iida, Takeshi, Mitsumizo, Kazutaka, Sato, Shuntaro, Doi, Mitsuru, Watanabe, Kounosuke, Ota, Shingo, Shiraishi, Kazuteru, Yonekura, Akihiko, and Osaki, Makoto

Published
2024
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14. Reasons for disengagement from antiretroviral care in the era of 'Treat All' in low‐ or middle‐income countries: a systematic review

Author

Rachael M. Burke, Hannah M. Rickman, Clarice Pinto, Peter Ehrenkranz, Augustine Choko, and Nathan Ford

Subjects
antiretroviral, care cascade, disengagement, loss to care, reasons, re‐engagement, Immunologic diseases. Allergy, RC581-607
Abstract

Abstract Introduction Disengagement from antiretroviral therapy (ART) care is an important reason why people living with HIV do not achieve viral load suppression become unwell. Methods We searched two databases and conference abstracts from January 2015 to December 2022 for studies which reported reasons for disengagement from ART care. We included quantitative (mainly surveys) and qualitative (in‐depth interviews or focus groups) studies conducted after “treat all” or “Option B+” policy adoption. We used an inductive approach to categorize reasons: we report how often reasons were reported in studies and developed a conceptual framework for reasons. Results We identified 21 studies which reported reasons for disengaging from ART care in the “Treat All” era, mostly in African countries: six studies in the general population of persons living with HIV, nine in pregnant or postpartum women and six in selected populations (one each in people who use drugs, isolated indigenous communities, men, women, adolescents and men who have sex with men). Reasons reported were: side effects or other antiretroviral tablet issues (15 studies); lack of perceived benefit of ART (13 studies); psychological, mental health or drug use (13 studies); concerns about stigma or confidentiality (14 studies); lack of social or family support (12 studies); socio‐economic reasons (16 studies); health facility‐related reasons (11 studies); and acute proximal events such as unexpected mobility (12 studies). The most common reasons for disengagement were unexpected events, socio‐economic reasons, ART side effects or lack of perceived benefit of ART. Conceptually, studies described underlying vulnerability factors (individual, interpersonal, structural and healthcare) but that often unexpected proximal events (e.g. unanticipated mobility) acted as the trigger for disengagement to occur. Discussion People disengage from ART care for individual, interpersonal, structural and healthcare reasons, and these reasons overlap and interact with each other. While HIV programmes cannot predict and address all events that may lead to disengagement, an approach that recognizes that such shocks will happen could help. Conclusions Health services should focus on ways to encourage clients to engage with care by making ART services welcoming, person‐centred and more flexible alongside offering adherence interventions, such as counselling and peer support.

Published
2024
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15. Process Evaluation of Services for HIV-Infected Post-Partum Women and HIV-Exposed Infants in Primary Health Care Blantyre Malawi

Author

Leticia Chimwemwe Suwedi-Kapesa, Alinane Linda Nyondo-Mipando, Augustine Choko, Angela Obasi, Peter MacPherson, and Nicola Desmond

Subjects
Medicine (General), R5-920, Public aspects of medicine, RA1-1270
Abstract

HIV testing among HIV-exposed infants (HEI) in Malawi is below global targets and, affected by low utilisation of health services after birth. We conducted a mixed methods evaluation of the implementation of services for early infant diagnosis (EID) of HIV against national guidelines in Blantyre, Malawi, to inform the development of strategies to improve EID services uptake. We estimated coverage of HEI enrolment in HIV care and HIV testing at 6 weeks through a retrospective data review. We qualitatively explored implementation gaps in EID services through process mapping of 8 mother-infant pairs (MIP); and investigated healthcare workers’ (HCW) perspectives on the implementation gaps through group interviews with 16 HCWs. We analysed the quantitative data descriptively and conducted a thematic content analysis of qualitative data. Of 163 HEIs born at the study sites, 39 (24%) were enrolled in an HIV care clinic before post-natal discharge, and 85 (52%) received HIV testing by 6 weeks. The median time for MIP to receive EID services was 4 (1-8) hours. The implementation gaps observed during process mapping included: failure to identify and enrol HEI in HIV care clinic; lack of immunisation, counselling for HEI testing, HIV testing, drug refilling, and family planning; and different appointment dates for mother and infant. HCWs reported delays and gaps influencing optimal service provision including: lack of screening to identify MIP, limited supervision for student HCWs when providing services, inadequate capacity of point of care machines, challenges with integrating services, and role confusion. Use of unique identifiers for MIP and establishing a booking system to schedule appointments to suit point of care machine capacity were primary service improvement recommendations. This study identified suboptimal EID services in Malawi due to process, capacity, and system factors. Context-appropriate interventions accommodating systems thinking are needed to enhance service provision.

Published
2024
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16. Multimorbidity-associated emergency hospital admissions: a 'screen and link' strategy to improve outcomes for high-risk patients in sub-Saharan Africa: a prospective multicentre cohort study protocol [version 1; peer review: 1 approved, 2 approved with reservations]

Author

Charity Salima, Francis Sakita, Ibrahim Simiyu, Hendry Sawe, Sarah Urasa, Miriam Taegtmeyer, Nateiya M. Yongolo, Sarah White, Ben Morton, Jamie Rylance, Felix Limbani, Eve Worrall, Stephen A. Spencer, Gimbo Hyuha, Alice Rutta, Augustine Choko, Gift Treighcy Banda, Julian T. Hertz, Paul Dark, Juma Mfinanga, Blandina T. Mmbaga, Adamson Muula, Rhona Mijumbi, Laura Rosu, Mulinda Nyirenda, Sangwani Salimu, and Matthew Rubach

Subjects
Multimorbidity, non-communicable diseases, hospital care, sub-Saharan Africa, health related quality of life, patient costs, eng, Medicine
Abstract

Background The prevalence of multimorbidity (the presence of two or more chronic health conditions) is rapidly increasing in sub–Saharan Africa. Hospital care pathways that focus on single presenting complaints do not address this pressing problem. This has the potential to precipitate frequent hospital readmissions, increase health system and out-of-pocket expenses, and may lead to premature disability and death. We aim to present a description of inpatient multimorbidity in a multicentre prospective cohort study in Malawi and Tanzania. Primary objectives Clinical: Determine prevalence of multimorbid disease among adult medical admissions and measure patient outcomes. Health Economic: Measure economic costs incurred and changes in health-related quality of life (HRQoL) at 90 days post-admission. Situation analysis: Qualitatively describe pathways of patients with multimorbidity through the health system. Secondary objectives Clinical: Determine hospital readmission free survival and markers of disease control 90 days after admission. Health Economic: Present economic costs from patient and health system perspective, sub-analyse costs and HRQoL according to presence of different diseases. Situation analysis: Understand health literacy related to their own diseases and experience of care for patients with multimorbidity and their caregivers. Methods This is a prospective longitudinal cohort study of adult (≥18 years) acute medical hospital admissions with nested health economic and situation analysis in four hospitals: 1) Queen Elizabeth Central Hospital, Blantyre, Malawi; 2) Chiradzulu District Hospital, Malawi; 3) Hai District Hospital, Boma Ng’ombe, Tanzania; 4) Muhimbili National Hospital, Dar-es-Salaam, Tanzania. Follow-up duration will be 90 days from hospital admission. We will use consecutive recruitment within 24 hours of emergency presentation and stratified recruitment across four sites. We will use point-of-care tests to refine estimates of disease pathology. We will conduct qualitative interviews with patients, caregivers, healthcare providers and policymakers; focus group discussions with patients and caregivers, and observations of hospital care pathways.

Published
2024
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17. Reasons for disengagement from antiretroviral care in the era of 'Treat All' in low‐ or middle‐income countries: a systematic review

Author

Burke, Rachael M., Rickman, Hannah M., Pinto, Clarice, Ehrenkranz, Peter, Choko, Augustine, and Ford, Nathan

Subjects
Patient compliance -- Evaluation, Antiviral agents -- Dosage and administration, Secondary data analysis -- Management, HIV infection -- Drug therapy, Company business management, Health
Abstract

: Introduction: Disengagement from antiretroviral therapy (ART) care is an important reason why people living with HIV do not achieve viral load suppression become unwell. Methods: We searched two databases and conference abstracts from January 2015 to December 2022 for studies which reported reasons for disengagement from ART care. We included quantitative (mainly surveys) and qualitative (in‐depth interviews or focus groups) studies conducted after “treat all” or “Option B+” policy adoption. We used an inductive approach to categorize reasons: we report how often reasons were reported in studies and developed a conceptual framework for reasons. Results: We identified 21 studies which reported reasons for disengaging from ART care in the “Treat All” era, mostly in African countries: six studies in the general population of persons living with HIV, nine in pregnant or postpartum women and six in selected populations (one each in people who use drugs, isolated indigenous communities, men, women, adolescents and men who have sex with men). Reasons reported were: side effects or other antiretroviral tablet issues (15 studies); lack of perceived benefit of ART (13 studies); psychological, mental health or drug use (13 studies); concerns about stigma or confidentiality (14 studies); lack of social or family support (12 studies); socio‐economic reasons (16 studies); health facility‐related reasons (11 studies); and acute proximal events such as unexpected mobility (12 studies). The most common reasons for disengagement were unexpected events, socio‐economic reasons, ART side effects or lack of perceived benefit of ART. Conceptually, studies described underlying vulnerability factors (individual, interpersonal, structural and healthcare) but that often unexpected proximal events (e.g. unanticipated mobility) acted as the trigger for disengagement to occur. Discussion: People disengage from ART care for individual, interpersonal, structural and healthcare reasons, and these reasons overlap and interact with each other. While HIV programmes cannot predict and address all events that may lead to disengagement, an approach that recognizes that such shocks will happen could help. Conclusions: Health services should focus on ways to encourage clients to engage with care by making ART services welcoming, person‐centred and more flexible alongside offering adherence interventions, such as counselling and peer support., INTRODUCTION Since 2015, WHO has recommended that people living with HIV be offered antiretroviral therapy (ART) irrespective of clinical staging or CD4 count [1]. The rollout of this “Treat All” [...]

Published
2024
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20. Creating a best practice template for participant communication plans in global health clinical studies

Author

Colleen E. Shelly, Caroline Logan, Beth Skorochod, Alison Wiyeh, Duduzile Ndwandwe, Augustine Choko, Innocent Valea, and Boghuma K. Titanji

Subjects
Communication plan, Clinical trial, Global health, Clinical trial participant, Medicine (General), R5-920
Abstract

Abstract Background Clinical trial participants have a right to be informed throughout the entire process of human subject research. As part of this pillar of research ethics, participants and other stakeholders should be made aware of research findings after a trial has been completed. Though participants have both a right, and a desire to be informed of research outcomes, studies show that they rarely receive communication about study findings. Our aim was (1) to understand what, if any, role communication plans play in current global health clinical research protocols and (2) to use our findings to develop a communication plan template tailored to clinical research carried out in low-and-middle-income countries (LMIC) while minimizing colonial assumptions. While the template was drafted in the LMIC context, the principles are universally applicable and should be considered best practices for all global health clinical trials. Methods We carried out a mixed-method study over a period of 6 months to understand the role of communication with study participants and other stakeholders in clinical trials. The semiquantitative analysis included mining publicly available clinical trial protocols for communication-related language. Qualitative interviews (n = 7) were used to gather knowledge and insight from clinical trial experts to inform the development of a communication plan template. Results None of the 48 mined clinical trial protocols included a communication plan. Of the 48, 21% (n = 21) protocols included communication-related language, and 10% (n = 5) described plans to share trial results with participants. Conclusion The use of communication plans in global health clinical trials is lacking. To our knowledge, this is the first in-depth analysis of communication plans in clinical trials to date. We recommend that researchers utilize the developed communication plan template throughout the entire research process to ensure a human-centered approach to participant communication. This communication plan should apply to all phases of a research trial, with a particular emphasis on plans to share results in an accessible and engaging manner once the trial has been completed.

Published
2023
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21. Identifying efficient linkage strategies for men (IDEaL): a study protocol for an individually randomised control trial

Author

Sam Phiri, Khumbo Phiri, Lawrence C Long, Thomas J Coates, Risa M Hoffman, Michal Kulich, Julie Hubbard, Kathryn Dovel, Brooke E Nichols, Kelvin Balakasi, Elijah Chikuse, and Augustine T Choko

Subjects
Medicine
Abstract

Introduction Men in sub-Saharan Africa are less likely than women to initiate antiretroviral therapy (ART) and more likely to have longer cycles of disengagement from ART programmes. Treatment interventions that meet the unique needs of men are needed, but they must be scalable. We will test the impact of various interventions on 6-month retention in ART programmes among men living with HIV who are not currently engaged in care (never initiated ART and ART clients with treatment interruption).Methods and analysis We will conduct a programmatic, individually randomised, non-blinded, controlled trial. ‘Non-engaged’ men will be randomised 1:1:1 to either a low-intensity, high-intensity or stepped arm. The low-intensity intervention includes one-time male-specific counseling+facility navigation only. The high-intensity intervention offers immediate outside-facility ART initiation+male-specific counselling+facility navigation for follow-up ART visits. In the stepped arm, intervention activities build in intensity over time for those who do not re-engage in care with the following steps: (1) one-time male-specific counselling+facility navigation→(2) ongoing male mentorship+facility navigation→(3) outside-facility ART initiation+male-specific counselling+facility navigation for follow-up ART visits. Our primary outcome is 6-month retention in care. Secondary outcomes include cost-effectiveness and rates of adverse events. The primary analysis will be intention to treat with all eligible men in the denominator and all men retained in care at 6 months in the numerator. The proportions achieving the primary outcome will be compared with a risk ratio, corresponding 95% CI and p value computed using binomial regression accounting for clustering at facility level.Ethics and dissemination The Institutional Review Board of the University of California, Los Angeles and the National Health Sciences Research Council in Malawi have approved the trial protocol. Findings will be disseminated rapidly in national and international forums and in peer-reviewed journals and are expected to provide urgently needed information to other countries and donors.Trial registration number NCT05137210.Date and version 5 May 2023; version 3.

Published
2023
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22. Correlates of prior HIV testing and schistosomiasis treatment: Baseline survey findings from the 'creating demand for fishermen's schistosomiasis HIV services' (FISH) cluster-randomized trial in Mangochi, Malawi.

Author

Geoffrey Kangogo, Donaldson F Conserve, Sekeleghe Kayuni, Moses K Kumwenda, Kathryn L Dovel, James Chirombo, Peter MacPherson, Elizabeth L Corbett, Anthony Butterworth, and Augustine Talumba Choko

Subjects
Arctic medicine. Tropical medicine, RC955-962, Public aspects of medicine, RA1-1270
Abstract

BackgroundFishing exposes fishermen to schistosomiasis-infested fresh water and concurrently through precarious livelihoods to risky sexual behaviour, rendering these two infections occupational hazards for fishermen. This study aimed to characterize the knowledge of the two conditions to obtain necessary data for a subsequent cluster randomized trial designed to investigate demand creation strategies for joint HIV-schistosomiasis service provision in fishing villages on the shores of southern Lake Malawi.MethodsEnumeration of all resident fishermen in 45 clusters (fishing communities) was carried out between November 2019 and February 2020. In a baseline survey, fishermen reported their knowledge, attitudes and practices in the uptake of HIV and schistosomiasis services. Knowledge of HIV status and previous receipt of praziquantel were modelled using random effects binomial regression, accounting for clustering. Prevalence of willingness to attend a beach clinic was computed.ResultsA total of 6,297 fishermen were surveyed from the 45 clusters with harmonic mean number of fishermen per cluster of 112 (95% CI: 97; 134). The mean age was 31.7y (SD: 11.9) and nearly 40% (2,474/6,297) could not read or write. Overall, 1,334/6,293 (21.2%) had never tested for HIV, with 64.4% (3,191/4,956) having tested in the last 12 months, and 5.9% (373/6290) taking antiretroviral therapy (ART). In adjusted analyses, being able to read and write (adjusted risk ratio [aRR: 1.91, 95% CI: 1.59-2.29, pConclusionIn a setting with an underlying high prevalence of both HIV and schistosomiasis, we found low knowledge of HIV status and low utilization of free schistosomiasis treatment. Among fishermen who accessed HIV services, there was a very high likelihood of taking praziquantel suggesting that integrated service delivery may lead to good coverage.Trial registrationThis trial is registered in the ISRCTN registry: ISRCTN14354324; date of registration: 05 October 2020.

Published
2023
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24. ESG Reporting And Disclosure Mandates: Legal Obligations And Optimal Practices

Author

Ajunwo-Choko, Blessing

Subjects
Corporate governance -- Laws, regulations and rules, Strategic planning (Business) -- Methods, Sustainability reporting -- Laws, regulations and rules, Government regulation, Business, international
Abstract

INTRODUCTION: The market landscape has undergone significant transformations, with heightened expectations from both consumers and employees towards corporate entities. Business owners and industry leaders face mounting pressure from regulators and [...]

Published
2024

25. Safeguarding Intellectual Property Rights In The Era Of Social Media: Challenges And Strategies For Businesses In Nigeria

Author

Ajunwo-Choko, Blessing

Subjects
Social media -- Forecasts and trends -- Laws, regulations and rules, Intellectual property law -- Interpretation and construction -- Forecasts and trends, Government regulation, Market trend/market analysis, Business, international
Abstract

Introduction The emergence of social media has remarkably redefined human interactions, making communication more interactive and immediate. With platforms such as Facebook, X, Instagram, YouTube, TikTok, and LinkedIn ingrained in [...]

Published
2024

27. Randomized controlled trial of daily teriparatide, weekly high-dose teriparatide, or bisphosphonate in patients with postmenopausal osteoporosis: The TERABIT study

Author

Chiba, Ko, Okazaki, Narihiro, Kurogi, Ayako, Watanabe, Tsuyoshi, Mori, Ai, Suzuki, Nobuhiko, Adachi, Koichi, Era, Makoto, Yokota, Kazuaki, Inoue, Takuma, Yabe, Yoshihiro, Furukawa, Keizo, Kondo, Choko, Tsuda, Keiichi, Ota, Shingo, Isobe, Yusaku, Miyazaki, Satsuki, Morimoto, Shimpei, Sato, Shuntaro, Nakashima, Sawako, Tashiro, Shigeki, Yonekura, Akihiko, Tomita, Masato, and Osaki, Makoto

Published
2022
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28. Mobility and ART retention among men in Malawi: a mixed‐methods study

Author

Marguerite Thorp, MacDaphton Bellos, Tijana Temelkovska, Misheck Mphande, Morna Cornell, Julie Hubbard, Augustine Choko, Thomas J. Coates, Risa Hoffman, and Kathryn Dovel

Subjects
Africa, antiretroviral therapy, emigration and immigration, HIV, men, retention in care, Immunologic diseases. Allergy, RC581-607
Abstract

Abstract Introduction Mobility is associated with worse outcomes across the HIV treatment cascade, especially among men. However, little is known about the mechanisms that link mobility and poor HIV outcomes and what types of mobility most increase the risk of treatment interruption among men in southern Africa. Methods From August 2021 to January 2022, we conducted a mixed‐methods study with men living with HIV (MLHIV) but not currently receiving antiretroviral therapy (ART) in Malawi. Data collection was embedded within two larger trials (ENGAGE and IDEaL trials). We analysed baseline survey data of 223 men enrolled in the trials who reported being mobile (defined as spending ≥14 nights away from home in the past 12 months) using descriptive statistics and negative binomial regressions. We then recruited 32 men for in‐depth interviews regarding their travel experiences and ART utilization. We analysed qualitative data using constant comparative methods. Results Survey data showed that 34% of men with treatment interruptions were mobile, with a median of 60 nights away from home in the past 12 months; 69% of trips were for income generation. More nights away from home in the past 12 months and having fewer household assets were associated with longer periods out of care. In interviews, men reported that travel was often unplanned, and men were highly vulnerable to exploitive employer demands, which led to missed appointments and ART interruption. Men made major efforts to stay in care but were often unable to access care on short notice, were denied ART refills at non‐home facilities and/or were treated poorly by providers, creating substantial barriers to remaining in and returning to care. Men desired additional multi‐month dispensing (MMD), the ability to refill treatment at any facility in Malawi, and streamlined pre‐travel refills at home facilities. Conclusions Men prioritize ART and struggle with the trade‐offs between their own health and providing for their families. Mobility is an essential livelihood strategy for MLHIV in Malawi, but it creates conflict with ART retention, largely due to inflexible health systems. Targeted counselling and peer support, access to ART services anywhere in the country, and MMD may improve outcomes for mobile men.

Published
2023
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29. Engaging men through HIV self-testing with differentiated care to improve ART initiation and viral suppression among men in Malawi (ENGAGE): A study protocol for a randomized control trial.

Author

Augustine T Choko, Thomas J Coates, Misheck Mphande, Kelvin Balakasi, Isabella Robson, Khumbo Phiri, Sam Phiri, Michal Kulich, Michael Sweat, Morna Cornell, Risa M Hoffman, and Kathryn Dovel

Subjects
Medicine, Science
Abstract

BackgroundMen experience twice the mortality of women while on ART in sub-Saharan Africa (SSA) largely due to late HIV diagnosis and poor retention. Here we propose to conduct an individually randomized control trial (RCT) to investigate the impact of three-month home-based ART (hbART) on viral suppression among men who were not engaged in care.Methods and designA programmatic, individually randomized non-blinded, non-inferiority-controlled trial design (ClinicalTrials.org NCT04858243). Through medical chart reviews we will identify "non-engaged" men living with HIV, ≥15years of age who are not currently engaged in ART care, including (1) men who have tested HIV-positive and have not initiated ART within 7 days; (2) men who have initiated ART but are at risk of immediate default; and (3) men who have defaulted from ART. With 1:1 computer block randomization to either hbART or facility-based ART (fbART) arms, we will recruit men from 10-15 high-burden health facilities in central and southern Malawi. The hbART intervention will consist of 3 home-visits in a 3-month period by a certified male study nurse ART provider. In the fbART arm, male participants will be offered counselling at male participant's home, or a nearby location that is preferred by participants, followed with an escort to the local health facility and facility navigation. The primary outcome is the proportion of men who are virally suppressed at 6-months after ART initiation. Assuming primary outcome achievement of 24.0% and 33.6% in the two arms, 350 men per arm will provide 80% power to detect the stated difference.DiscussionIdentifying effective ART strategies that are convenient and accessible for men in SSA is a priority in the HIV world. Men may not (re-)engage in facility-based care due to a myriad of barriers. Two previous trials investigated the impact of hbART on viral suppression in the general population whereas this trial focuses on men. Additionally, this trial involves a longer duration of hbART i.e., three months compared to two weeks allowing men more time to overcome the initial psychological denial of taking ART.

Published
2023
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31. Effect of postpartum anaemia on maternal health-related quality of life: a systematic review and meta-analysis

Author

Ernest Moya, Nomsa Phiri, Augustine T. Choko, Martin N. Mwangi, and Kamija S. Phiri

Subjects
Anaemia, Iron deficiency anaemia, Depression, Fatigue, Mother–child interaction, Systematic review, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Postpartum anaemia remains a persistent and severe public health issue in many parts of the world. Studies have reported mixed findings on the effects of anaemia during the postpartum period on maternal health-related quality of life (HRQoL). We conducted this systematic review to summarise available evidence to inform public health practitioners on whether 1) anaemia negatively impact maternal health-related quality of life and 2) whether iron supplementation in anaemic women can improve maternal HRQoL during the postpartum period. Methods This review’s protocol was registered online with PROSPERO (CRD42020206618). We extensively searched Embase, PubMed, Cochrane and Scopus through the HINARI website to identify studies that reported either association or effect of postpartum anaemia on fatigue, depression and mother–child interaction. We restricted our search to studies of human females published in English language from databases inception until August 2020. We followed a Cochrane guideline for reporting systematic reviews and meta-analysis to synthesise data. Results Twenty-seven studies were included in this systematic review, with some reporting all three domains (fatigue, depression and mother–child interaction) of HRQoL. Seven observational studies with pooled dichotomous outcomes showed that iron deficient or anaemic women were 1.66 times more likely to experience symptoms of depression than non-anaemic or iron-replete women [RR = 1.66 (95% CI: 1.28; 2.16), I2 = 67.0%, P

Published
2022
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32. Investigating interventions to increase uptake of HIV testing and linkage to care or prevention for male partners of pregnant women in antenatal clinics in Blantyre, Malawi

Author

Choko, A. T., Fielding, K., and Corbett, E. L.

Subjects
610
Abstract

Improved availability of HIV tests has led to increases in numbers testing and starting treatment in sub-Saharan Africa. Despite such remarkable progress, men continue to lag behind in HIV testing in the region including men in well-established heterosexual relationships, in which context HIV transmission is surprisingly high. We previously found HIV self-testing (HIVST) to be very effective at increasing the uptake of HIV testing in the general population in urban Blantyre, Malawi. This PhD investigated the effect of partner-delivered HIVST, providing HIVST kits to pregnant women in antenatal clinics (ANC) with or without additional interventions, including financial incentives, on uptake of testing and linkage to care or prevention. The PhD is made up of three main pieces of work: First, a systematic review was conducted to investigate the existing evidence regarding the effectiveness of demand-side (given to users) financial incentives on linkage to HIV treatment or voluntary medical male circumcision (VMMC) in low and middle income (LMIC) countries. Relevant electronic databases and conference proceedings were searched for randomised controlled trials. Seven trials were identified out of 1099 citations, with all showing significant improvement in linkage: four investigated VMMC and three investigated ART. Manuscript currently under review. Secondly, a formative study was carried out to identify additional potential interventions and to refine interventions identified as promising through the systematic review, before being tested in a subsequent trial. Undertaking this formative study ensured that interventions being considered for inclusion in the trial design were adapted to the local environment and prevailing social norms, by seeking input and feedback from would-be users of the service. Paper published in J Int AIDS Soc, 2017. Thirdly, a multi-arm two-stage cluster-randomised trial was conducted in Blantyre, Malawi. The paper describing the trial design is published in Trials, 2017; trial results manuscript is under review. Antenatal care clinic days were randomized to standard of care (SOC: personalised invitation to male friendly clinic for standard HIV testing and fast-track referral for HIV treatment or VMMC services) or one of five intervention arms: SOC plus two partner-delivered self-test kits with a) no addition, or financial incentives of b) US$3, c) US$10, d) lottery (10% chance of winning $30), or e) phone call. All incentives were conditional on attending the male friendly clinic. The primary outcome at 28 days, measured through attendance at the male friendly clinic, was: referral for antiretroviral therapy (ART) for HIV-positive men; or voluntary male medical circumcision (VMMC) scheduled if HIV-negative/uncircumcised; or counselling if HIV-negative/circumcised. At the end of stage 1, a planned interim analysis was performed and the HIVST-lottery arm was dropped for futility. Male partner HIV-testing was substantially increased in all HIVST arms (range 87.0% to 95.4% in the 5 arms, compared to 17.4% in the SOC arm), according to self-report by the woman at 28 days. Reaching the primary linkage outcome at 28 days was most likely for the partners of participants in clinic days randomised to the HIVST-$3 and the HIVST-$10 arms, with geometric means of 40.9% (adjusted risk ratio [aRR] 3.01, 95%CI:1.63-5.57) and 51.7% (aRR 3.72, 95%CI:1.85-7.48), respectively. Successful male linkage was also more likely in the HIVST-phone reminder (geometric mean 22.3%, aRR 1.58, 95%CI:1.07-2.33) and HIVST-alone (geometric mean 17.5%: aRR 1.45 (95%CI:0.99-2.13) compared to SOC (13.0%). Linkage in the HIVST-lottery arm (geometric mean 18.6%, aRR 1.43, 95%CI:0.96-2.13) was less pronounced than with the $3 or $10 fixed conditional-incentives, and clients disliked the uncertainty. Overall, 42/46 (91.3%) newly diagnosed HIV-positive men initiated ART and 135/222 (60.8%) HIV-negative and previously uncircumcised men had VMMC. No serious adverse events were reported. Cost per male partner attended clinic with confirmed HIV test result was $23.73 and $28.08 for $10 and $3 arms, respectively. Secondary distribution of HIVST kits from ANC clinics greatly increased partner-testing, and timely linkage within 28 days increased 3-fold with the combination of fixed financial incentives plus partner-delivered HIV self-test kits in this hard to reach group. This PhD project has demonstrated that novel trial designs such as adaptive MAMS can be applied to address pressing public health problems in Africa. The approach followed here, combining systematic review, qualitative pilot study, and multi-arm randomised trial is ideal for rapidly generating high quality evidence for interventions, such as financial incentives, where the effectiveness of different amounts may vary from one setting to the next.

Published
2018
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34. Investigating the effectiveness of web‐based HIV self‐test distribution and linkage to HIV treatment and PrEP among groups at elevated risk of HIV in Viet Nam provinces: a mixed‐methods analysis of implementation from pilot to scale‐up

Author

Nguyen, Van Thi Thuy, Dunkley, Yasmin, Son, Vo Hai, Choko, Augustine T., Huong, Phan Thi Thu, Manh, Pham Duc, Truong, Truong Minh, Truc, Huynh Minh, Giang, Dap Thanh, Tung, Le Thanh, Hoa, Van Dinh, Baggaley, Rachel, and Johnson, Cheryl

Subjects
PRE-exposure prophylaxis, HIV testing kits, HIV, PATIENT self-monitoring, ANTIRETROVIRAL agents, THEMATIC analysis
Abstract

Introduction: In Viet Nam, key populations (KPs) face barriers accessing HIV services. Virtual platforms can be leveraged to increase access for KPs, including for HIV self‐testing (HIVST). This study compares reach and effectiveness of a web‐based HIVST intervention from pilot to scale‐up in Viet Nam. Methods: A mixed‐methods explanatory sequential design used cross‐sectional and thematic analysis. The pilot launched in Can Tho in November 2020, followed by Hanoi and Nghe An in April 2021. Scale‐up included Can Tho and Nghe An, with 21 novel provinces from April to December 2022. After risk assessment, participants registered on the website, receiving HIVST (OraQuick®) by courier, peer educator or self‐pick‐up. Test result reporting and completing satisfaction surveys were encouraged. Intervention reach was measured through numbers accessing the testing, disaggregated by demographics, and proportion of individuals reporting self‐testing post‐registration. Effectiveness was measured through numbers reporting self‐test results, testing positive and linking to care, and testing negative and using HIVST to manage pre‐exposure prophylaxis (PrEP) use. Thematic content analysis of free‐text responses from the satisfaction survey synthesized quantitative outcomes. Results: In total, 17,589 participants registered on the HIVST website; 11,332 individuals ordered 13,334 tests. Participants were generally young, aged <25 years (4309/11,332, 38.0%), male (9418/11,332, 83.1%) and men who have sex with men (6437/11,332, 56.8%). Nearly half were first‐time testers (5069/11,332, 44.9%). Scale‐up participants were two times more likely to be assigned female at birth (scale‐up; 1595/8436, 18.9% compared to pilot; 392/3727, 10.5%, p < 0.001). Fewer test results were reported in scale‐up compared with pilot (pilot: 3129/4140, 75.6%, scale‐up: 5811/9194, 63.2%, p < 0.001). 6.3% of all tests were reactive (pilot: 176/3129, 5.6% reactive compared to scale‐up: 385/5811, 6.6% reactive, p = 0.063); of which most linked to care (509/522, 97.5%). One‐fifth of participants with a negative test initiated or continued PrEP (pilot; 19.8%, scale‐up; 18.5%, p = 0.124). Thematic analysis suggested that community delivery models increased programmatic reach. Live chat may also be a suitable proxy for staff support to increase result reporting. Conclusions: Web‐based self‐testing in Viet Nam reached people at elevated risk of HIV, facilitating uptake of anti‐retroviral treatment and direct linkage to PrEP initiations. Further innovations such as the use of social‐network testing services and incorporating features powered by artificial intelligence could increase the effectiveness and efficiency of the approach. [ABSTRACT FROM AUTHOR]

Published
2024
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40. Effects of Coronavirus Disease Pandemic on Tuberculosis Notifications, Malawi

Author

Soko, Rebecca Nzawa, Burke, Rachael M., Feasey, Helena R.A., Sibande, Wakumanya, Nliwasa, Marriott, Henrion, Marc Y.R., Khundi, McEwen, Dodd, Peter J., Ku, Chu Chang, Kawalazira, Gift, Choko, Augustine T., Divala, Titus H., Corbett, Elizabeth L., and MacPherson, Peter

Subjects
Epidemics -- Statistics -- Influence -- Control -- Malawi, Tuberculosis -- Statistics -- Diagnosis -- Care and treatment, Health
Abstract

Tuberculosis (TB) is a major killer, causing [approximately equal to] 1,4 million deaths worldwide annually (1), making it second only to coronavirus disease (COVID-19) as the biggest cause of infectious [...]

Published
2021
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41. Men’s comfort in distributing or receiving HIV self-test kits from close male social network members in Dar Es Salaam, Tanzania: baseline results from the STEP project

Author

Joseph K. B. Matovu, Gaspar Mbita, Akeen Hamilton, Frank Mhando, Wynton M. Sims, Noah Thompson, Albert N. Komba, Jackson Lija, Jiajia Zhang, Thomas van den Akker, Dustin T. Duncan, Augustine T. Choko, and Donaldson F. Conserve

Subjects
HIV, Men, HIV self-testing, Social networks, Tanzania, Public aspects of medicine, RA1-1270
Abstract

Abstract Background A variety of strategies have been used to reach men with HIV self-testing services, including social network-based HIV self-test kits distribution. However, few studies have assessed men’s comfort to distribute to or receive HIV self-test kits from close male friends within the same social network. In this study, we assessed men’s comfort to distribute to and/or receive HIV self-test kits from close male friends and associated factors among men who socialize in networks locally referred to as “camps” in Tanzania. Methods Data are from the baseline survey of a cluster-randomized controlled trial conducted in June 2019 with 18 social networks or “camps” in Dar es Salaam, Tanzania. Participants were 18-year-old or older male camp members who were HIV-negative at the time of enrolment. We used the Generalized Estimating Equations (GEE) to assess factors associated with being comfortable to distribute to and/or receive HIV self-test kits from close male members within one’s social network. Results Of 505 participants, 67.9% (n = 342) reported being comfortable to distribute to while 68.2% (n = 344) were comfortable to receive HIV self-test kits from their close male friends. Ever having heard about HIV self-testing (Adjusted Prevalence Ratio (Adj. PR): 1.6; 95% Confidence Interval [CI]: 1.3, 1.9), willingness to self-test for HIV in front of a sexual partner (Adj. PR: 3.0; 95%CI: 1.5, 6.1) and exposure to peer-led HIV self-testing education and promotion (Adj. PR: 1.4; 95%CI: 1.2, 1.7) were significantly associated with being comfortable to distribute HIV self-test kits to close male members within one’s social network. Similar results were observed for being comfortable to receive HIV self-test kits from a close male friend within one’s social network. Conclusions Overall, these findings suggest that distribution of HIV self-test kits through close male friends could improve the proportion of men reached with HIV self-testing services and improve HIV testing rates in this population where uptake remains low. However, additional promotional strategies such as peer-led HIV self-testing education are needed to raise awareness and increase the proportion of men who are comfortable to receive and/or distribute HIV self-testing kits.

Published
2021
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42. Effects of Coronavirus Disease Pandemic on Tuberculosis Notifications, Malawi

Author

Rebecca Nzawa Soko, Rachael M. Burke, Helena R.A. Feasey, Wakumanya Sibande, Marriott Nliwasa, Marc Y.R. Henrion, McEwen Khundi, Peter J. Dodd, Chu Chang Ku, Gift Kawalazira, Augustine T. Choko, Titus H. Divala, Elizabeth L. Corbett, and Peter MacPherson

Subjects
respiratory infections, severe acute respiratory syndrome coronavirus 2, SARS-CoV-2, SARS, COVID-19, coronavirus disease, Medicine, Infectious and parasitic diseases, RC109-216
Abstract

The coronavirus disease (COVID-19) pandemic might affect tuberculosis (TB) diagnosis and patient care. We analyzed a citywide electronic TB register in Blantyre, Malawi and interviewed TB officers. Malawi did not have an official COVID-19 lockdown but closed schools and borders on March 23, 2020. In an interrupted time series analysis, we noted an immediate 35.9% reduction in TB notifications in April 2020; notifications recovered to near prepandemic numbers by December 2020. However, 333 fewer cumulative TB notifications were received than anticipated. Women and girls were affected more (30.7% fewer cases) than men and boys (20.9% fewer cases). Fear of COVID-19 infection, temporary facility closures, inadequate personal protective equipment, and COVID-19 stigma because of similar symptoms to TB were mentioned as reasons for fewer people being diagnosed with TB. Public health measures could benefit control of both TB and COVID-19, but only if TB diagnostic services remain accessible and are considered safe to attend.

Published
2021
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43. Risk factors for COVID-19-related in-hospital mortality in a high HIV and tuberculosis prevalence setting in South Africa: a cohort study

Author

Abdullah, Shaina, Abrahams, Fiona, Adams, Vincentius, Adnane, Fhima, Adoni, Sonia, Adoons, Dieketso Melitta, Africa, Veronique, Aguinaga, D, Akach, Susan, Alakram Khelawon, Prisha, Aldrich, George, Alesinloye, Olatunde, Aletta, Mathale Biniki, Alice, Mametja, Aphane, Tebogo, Archary, Moherndran, Arends, Felicity, Arends, Shireen, Aser, Munonde, Asmal, T, Asvat, Mohammed, Avenant, Theunis, Avhazwivhoni, Muvhali, Azuike, Magnolia, Baartman, Johanna, Babalwa, Dlava, Badenhorst, Johan, Badenhorst, Miranda, Badripersad, Bianca, Badul, Lalihla, Bagananeng, M, Bahle, Mncedisi, Balfour, Liezl, Baloyi, T C, Baloyi, S, Baloyi, Tinyiko, Baloyi, Tshepo Mpho, Banda, Thokozani, Barit, Shimon, Bartsch, Nicole, Bayat, Junaid, Bazana, Siyabulela, Beetge, Marlene, Bekapezulu, Nosindiso, Belebele, Rammala, Bella, Phala, Belot, Zanenkululeko, Bembe, Lindi Gladys, Bensch, Sonja, Beukes, Gishma, Bezuidenhout, Karla, Bhembe, Themba, Bikisha, N A, Bilenge, Ben, Bishop, Leesa, Biyela, Baphamandla, Blaauw, Cyntheola, Blaylock, Mark, Bodley, Nicola, Bogale, Power, Bokolo, Sibongile, Bolon, Stefan, Booysen, Mary, Booysen, Eldereze, Boretti, Lia, Borges, Paula, Boshoga, Millicent, Bosman, Natasha, Bosvark, Lucinda, Botes, Nicky, Botha, Adele, Botha, Chantall, Botha, Jana, botha, Chantall, Botha, Mandlakayise Irvin, Botha, Alet, Bradbury, Janet, Breakfast, Zandisile, Breed, Maria, Brenda, Molele, Brice, Moshito, Britz, Jolene, Brown, Amanda, Buchanan, T, Bucwa, Thozama, Burger, Crystelle, Busakwe, Ziyanda, Bushula, Nosiviwe, Buthelezi, Zinhle, Buthelezi, Dumsile, Buthelezi, Thubelihle, Buthelezi, Mpumelelo Basil, Buthelezi, Fundiswa Lidwina, Bux, Nadia, Buys, Christoff, Buys, Anneline, Caka, Ernestina, Canal, Armando Sanchez, Caroline, Sithole, Casper, Monrick, Cawood, Shannon, Cebisa, Oratile, Cele, Nothando, Cele, Sboniso, Cele, Sthembile Goodness, Chauke, Mkhacani, Chauke, Pinkie, Chelin, Nevil, Chen, Xiaohui, Chetty, Venmalla, Chetty, Kerisse, Cheu, Christinah, Chibabhai, Vindana, Chirima, Takudzwa, ChisaleMabotja, Mantwa, Chivenge, Charity, Choene, Ngoasheng, Choko, Mbali Nosisa, Choshi, Martin, Chowdhury, Sabbir, Christoforou, Anastacia, Chuene, S L S, Chueu, T S, Cilliers, Dale, Cilliers, Vanessa, Claassen, Marcel, Cloete, Jeané, Coelho, Chantelle, Coetzee, Carol, Coetzee, Hans Jurgens, Coetzee, Christine, Coetzee, Marelize, Coetzer, Dane, Coka, Sizwe, Colane, M, Combrink, Herkulaas, Conjwa, Songezo, Contrad, Colleen, Cornelissen, Faith, Cronje, Leezelle, Crouse, Christine, Dabi, Tshidi, Dandala, Ziyanda, Dangor, Ziyaad, Daniel, Gildenhuys, Daniel, Ngwana, Daumas, Alfred, Dauth, Madelein, David, Mongalo, Davids, Wayne, Daweti, Nozuko, Dawood, Halima, Dayile, Wandisa, De Bruin, B, De Klerk, Karin, De la Rosa, Tanya, de Nysschen, Marice, De vos, Marie, De Wet, Darien, Debising, Mohith, Deenadayalu, Darshan, Dekeda, Babalwa, Desiree, Mofokeng, Deysel, Annelise, Dhlamini, Abram, Diala, Makgethwa Dhlala, Diale, Mathapelo, Diketane, Bella, Dingani, Nosisa, Diniso, Siyabonga, Diphatse, Lesego, Diya, Anele, Dladla, Zihloniphile, Dladla, Nompumelelo, Dladla, Mlungisi, Dladla, Patience, Dlamini, Baphilie, Dlamini, Nonhlanhla, Dlamini, Linda, Dlamini, Nonzwakazi, Dlamini, Wendy, Dlamini, Ncomeka, Dlamini, Siyabonga, Dlamini, Nicodemus, Dlamini, Lebohang, Dlamini, Motshedise, Dlava, Babalwa Christine, Dlova, Phikiwe, Dlozi, Lindiwe, Doreen, Maenetja, Doyi, Vumile, Doyi, Athini, Du Plessis, Belinda, du Plessis, Johanna Aletta, du Plessis, Eddie, du Plessis, Nicolette, du Plessis, Karin, du Toit, Briette, du Toit, Narissa, Dube, Jabulile, Dubula, Athayanda, Duduzile, Msomi, Duiker, Sechaba, Duma, Unati Bongile, Duma, Kholiwe, Dunne, Kella, Dyantyi, Kholeka, Dyantyi, Avile, Dyasi, Simphiwe, Dyondzo, Chauke, Dyubhele, Phelisa, Dywili, B J, Edwards, Letitia, Eksteen, Madie, Ellis, Tersia, Ellis, Tia, Emmerson, Glenda, Enslin, Theusia, Epule, Odimula, Erasmus, Lana, Erick, Mathonsi, Etsane, Lerato, Eunice, Shimange, Fani, Zanele, Ferreira, Mariette, Finger-Motsepe, K L, Floris, Fabion, Fobo, Tseko, Fokotsane, Keresemetse, Fokwana, Duduzile Emmelda, Fords, Genevieve Marion, Fortein, Juanita, Fouche, Christine, Fourie, Rulandi, Frean, Andrew, Fredericks, Ludwig, Funda, Wandile, funjwa, kabelo, Futhane, Martha, Futuse, Amanda, Gabaediwe, Dora, Gabuza, Nonhlanhla, Galant, Janycke, Gama, Zanele, Gano, Thobile, Gardiner, Emma Cora, Gastrow, Henri, Gate, Kelly, Gaunt, Ben, Gavaza, Rikhotso, Gayi, Thapelo, Gcakasi, Nkosinathi, Gcobo, Nomusa, Geffen, Leon, Geldenhuys, S, George, Jenny, Gerber, Martha, Getyengana, Zolisa, Gigi, Nkululo, Gihwala, Radha, Gilliland, Mitchell, Gloria, Zandile, Glover, Elitia, Gokailemang, Ellen, Goosen, Suseth, Gopane, Maria, Gosa-Lufuta, Thandazile, Gosnell, Bernadett, Gouws, Sharleen, Govender, Christina, Govender, Raksha, Govender, Pearl, Govender, Sally, Govender, Roxanne, Govender, K, Govender, Savie, Govinden, Rashika, Gqabuza, Luphumlo, Gqaji, Nomthandazo, Gqetywa, Maneo, Green, Caroline, Green, Nathan, Green, Neera, Grobler, Hendrik, Groenwald, Pamela, Grootboom, Daniel, Gumede, Beatrice, Gumede, Nomonde, Gumede, Simphiwe, Gumede, Slindile, Gumede, Ntombikayise, Gumede, Zenande, Gxotiwe, Thandiswa, H L, Makhubela, Hadebe, Nonhlanhla, Hadebe, Skhumbuzo, Halkas, Christos, Hamer, Ansie, Hamida, Ebrahim, Hammond, Juan, Haniff, Sumayia, Hare, Annelise, Hattingh, lorinda, Hendricks, Thenjiwe, Henecke, Philip-George, Henly-Smith, Brends, Herselman, Glynis, Heymans, Ansie, Heyns, Chantel, Hlabahlaba, Golekane, Hlabangwane, Lucky, Hlamarisa, Simango, Hlanzi, Ntokozo, Hlela, Hlengiwe, Hlokwe, Katlego, Hlongwa, Thembinkosi, Hlongwana, Anele, Hlubi, Themba, Hobo, Tozama, Hopane, Nare Nathaniel, House, Mariska, Hudson, Catharina, Huysamen, Marinda, Indheren, Jezreen, Ingle, Samantha, Isaacs, Gavin, Isaacs, T S Thekiso, Itumeleng, Maringa, J van Rensburg, Karien, Jackson, Saloshni, Jacob, Neziswa, Jacobs, Burton, Jacobs, Tshireletso, Jacobs, Gugulethu, Jaftha, Mesadi, Jaji, Zimkhitha, Jali, 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Gugu, Klassen, Marilyn, Koeberg, Josehine, Koen, Marizel, Koena, Simphiwe, Kok, Ina, Kola, Imraan, Kolokoto, Karabo, Konar, Ramachandra, Kotsedi, Dr, Kotze, Jaline, Koupis, Martins, Kritzinger, Helen, Kruger, Marlize, Kruger, Henk, Kubayi, Tlangelani, Kubeka, Thabisile, Kubheka, Nonjabulo, Kubheka, Melusi, Kubheka, Sibusiso Clifford, Kubheka, Erol, Kumalo, Monica, Kunene, Thulani, Kunene, Siphilile Candy, Kunneke, Yvette, Kupa, R P, Kutama, Rachel, Kwakwazi, Nompumelelo, Kweyama, Lwanele, Labuschagne, Maureen, Labuschagne, Marina, Lakshman, Prabha, Lamani, Lungelo, Lamani, Thembela, Langa, Naomi, Langeni, Khangelani, Langeni, Aphelele, Langeni, Nwabisa Hazel, Langeveldt, Gena, Laubscher, Anchen, Le Roux, Laetitia, Leah, Magagane, Lebea, Collen, Lebea, Sello, Lebenya, Viyella Phumla Cynthia, Lebogang, Lorraine, Leboho, P K, Lee, Chantel, Lefakane, Kelebogile Rejoice, Legoabe, Zandile, Lekala, Patrick, Lekhoaba, Motsitsi, Lekunutu, Tanki Shadrack, Lerefolo, Galaletsang, Letebele, N, 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Magubane, Agretia Ntombizodwa, Magwai, R, Mahabane, D I, Mahabeer, Padmini, Mahadulula, Elsie, Mahanjana, Lungiswa, Maharaj, Amy, Mahlambi, Qedusiza, Mahlangu, Yvonne, Mahlangu, Lerato, Mahlangu, Ntombifikile, Mahlangu, Makhosazana, Mahlangu, Mahlatsi, Mahlasela, Penelope, Mahlatse, Thosago, Mahlobo, Regina, Mahole, Dikhing, Mahomed, Adam, Mahubane, Mapeu Debora, Mahume, Peter, Maifo, Lehlogonolo, Maimane, Vincent, Maimele, Petunia, Maine, Phakoe, Mainongwane, Patricia Senyanyathi, Majamani, Nomalungisa, Majozini, Amahle, Makalima, Noluthando, Makam, Nomfundo, Makamba, Khanyisa, Makan, R, Makarapa, Mashiane, Makgahlela, Malesela, Makgisa, Mogoiwa David, Makgomo, Makgoba, Makgopa, M A, Makhalema, Mabone, Makhanya, Lindokuhle Lizo, Makhanya, Philile Valentia, Makharaedzha, Tolerance, Makhathini, Nathi, Makhesi, Elizabeth, Makhubela, Cinile, Makhunga, Nkululeko Freedom, Makhupula, Nomalinge, Makhura, R R, Makola, Rangwato, Makuba, Zingisa, Makubalo, Asanda, Makumsha, Lonwabo, Makuya, George, Malaka, Levy Mmachuene, Malangeni, Themba, Malatji, M L, Malebana-Metsing, Pelonomi, Malek, Malek, Malevu, Luthando, Malgas, Juanita, Malgas, Dimakatso, Malope, Paul Makgasane, Malose, Monyeki, Maluleke, Katekani, Mambane, Kato, Mamorobela, Nthabiseng, Manamela, Kukami, Manana, Tshepo, Maneto, Sathiel, Manganye, Aron Kabelo, Mangena, Pheto, Mangoale, Anna, Mangozho, Tinotenda Florence, Manickchund, Pariva, Mankayi, Zandisile, Manning, Arthur, Manyaapelo, Kelebogile Manyaapelo, Manyane, Tabea, Manzana, Zoliswa, Manzini, Milton, Mapasa-Dube, Busisiwe, Maphumulo, Siboniso, Maphumulo, Ntombifuthi, Maponya, Sindy, Maponya, Khomotso Mumsy, Maponya, Napjadi, Maqubela, Lami, Maqubela, Lizeka, Maqungo, Vuyo, Marais, Marisa, Marais, Chantal, Maramba, Nondumiso, Mare, Annelize, Maredi, Madumetsa, Martins, Afikile, Marule, Johanna, Marumo, Refilwe, Masakona, N N, Masehla, Kedibone Vincentia, Maseko, Eric, Maselesele, Tshilidzi, Maselo, Mojalefa, Maseloa, M, Masemola, M E, Masemola, Thembi, 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Lindiwe, Mbanjwa, Bavumile, Mbasa, Ayanda, Mbatha, Nosimilo, Mbatha, Zanele, Mbatha, Rudolph Zenzele, Mbedzi, Gift, Mbizi, Tatenda Trevor, Mbonambi, Khumbulani, Mboniswa, Nondumiso, Mbonisweni, Nomfanelo, Mbuilu, Jody, Mbulawa, Siyabonga, Mbutho, Zama, Mbuzi, Natasha, Mchunu, Nonkululeko, Mchunu, Cyprian, Mchunu, Nokuzola, Mchunu, Masesi Thandeka, Mciteka, Vuyokazi, Mdaka, Solly, Mdakane, Neho, Mdediswa, Siyabonga, Mdima, Melusi, Mdima Masondo, Nozipho, Mdindana, Siviwe, Mdleleni, Ntombizikhona, Mdletshe, Sibusiso, Mdoda, Gcobisa Precious, Mdolo, Ntombi, Mdontsane, Anele, Mehta, Ruchikas, Memela, Philile Rittah, Methuse, Masande, Metshile, Keatlaretse, Metuse, Pheliswa, Meyer, Anton, Meyer, Gavin, Meyer, Cameron, Mfazwe, Sisonke, Mfecane, Andiswa, Mfecane, Bongeka, Mfeka, Nelisiwe, Mgaga, Busisiwe, Mgauli, Thandiwe Portia, Mgedezi, Thembekile, Mgedezi, Vuyokazi, Mgevane, Kalipile, Mgiba, Bongni, Mgoduka, Babalwa, Mhlaba, Patrick, Mhlaba, Zeldah, Mhlanga, Ntombizodwa, Mhlinza, Vangile, Mhlongo, Nokuthula, Mhlongo, sibongiseni, Mhlotshana, Unamandla, Mikateko, Mabaso, Minnie, Helena, Mintoor, Karen, Miyeni, Bongi, M J, Mabelane, Mjethu, Rosy, Mkhize, Gloria, Mkhize, Mvuselelo, Mkhize, Ntokozo Siyabonga, Mkhize, Victoria, Mkhize, Nomkhosi, Mkhize, Nokuthula, Mkhwanazi, Mathini, Mkile, Nolwandle, Mkise, Kholofelo, Mkiya, Nokwandiso, Mkongi, Pearl, Mkungeka, Mnonopheli, Mlahleki, Hlomile, Mlibali, Nolukholo, Mlungwana, Sakhumzi, Mmachele, Jonas, Mmateka, Mashatole, Mmokwa, Molebatsi, Mmutlane, Thembisa, Mndebele, Zanele Olive, Mngomezulu, Nonhlanhla, Mnguni, Noluthando Millicent, Mngunyana, Pumza, Mngunyana, Nomxolisi, Mngxekeza, Ntombebongo, Mnisi, Zenzele, Mnqayi, Hlengiwe Precious, Mnqayi, Phumzile, Mntungwa, Thabiso, Mnyaka, Siya, Mnyakeni, Ntombikayise, Mnyamana, Vuyani, Mnyipika, Nomzingisi, Moabelo, Koena, Moatshe, Mmakgoshi Alseria, Mochaki-Senoge, Jennifer, Moche, Sharon, Mocwagae, Tebello, Modibane, Koeikantse, Modimoeng, Tebogo godfrey, Modisa, Obakeng, 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Molehe, Kgopa Stanley, Moleme, Kgomotso, Moliane, Sarah, Moloi, Fanyana, Molorane, Retshepile Joseph, Molotsi, Glenda Tsholanang, Molukanele, Lerato, Monareng, Joy, Moncho, Thapelo, Monica, Modiadie, Monnane, Refilwe, Monqo, Andile, Montewa, Neo, Montsioa, Kgalalelo, Monyaki, Reitumetse, Monyane, Masekhobe Jeanett, Monyela, Lipson, Moodley, Yudeshan, Moodley, Kriesen, Moodley, Kaira, Mooka, Boitumelo Donald, Moonsamy, Prea, Moopanar, Simmi, Moore, David, Mophethe, Lineo, Moremedi, Tshegohatso, Moremong, Kealeboga, Morgan, Nthangeni, Moripa, Egma, Morris, Lulamile, Mosala, Me. A.M., Mosana, Thabo, Mosase, Alice, Mose, Yolanda, Mosehlo, Maponya, Moseki, Mothusi, Moshabe, Mojalefa David, Moshai, D A, Moshani, Mbulelo, Moshani, Pelisa, Mosima, Ledwaba, Mosima, Ezrom, Mosoma, M P, Motaung, Lebohang, Motaung, Mokete, Motaung Xhama, Thozama Charmain, Motha, Purine Khethiwe, Motimele, Lerato, Motimeng, Boitumelo, Motladiile, Shirley, Motlhabane, Otsile, Motlhamme, Joshua, Motloba, Mandla, Motse, Kagiso, Motshegoa, Sophia, Moutlana, Edward, Mouton, Irma, Moya, Zanele, Moyake, Nomonde, M P, Maja, Mpete, Jenny, Mpfuni, Luamba Meltha, Mphahlele, Seputule Mphahlele, Mphake, Mashadi, Mphanya, Ephraim Letlhogonolo, Mphaphuli, Mashudu, Mphela, Tebogo Chwene, Mpontshane, MS, Mqotyana, Thabile, Mqungquthu, Babalwa, Msane, Noluthando Busane, Mseleku, Malusi, Msibi, Sibusiso, Msibi, Mancele, Msibi, Thulisile, Msibi, Siyabonga Linda, Msiza, Clement Nhlanhla, Msomi, Lungelo, Mtatambi, Mandlenkosi, Mthathambi, Thembisa, Mthembu, December, Mthembu, Nhlahla, Mthembu, Fezile Mbali, Mthembu, Lungiswa, Mthethwa, Nompumelelo Petunia, Mthimkhulu, Khulekani, Mthuli, Lungani Percival, Mthunzi, Ashley, Mtolo, Xolani Sydney, Mtolo, Nomonde Precious, Mtshali, Linda, Mtwa, Neliswa, Mtyobile, Fezeka, Mtyobile, Kanyisa, Mudau, Mpfariseni, Muemeleli, Magwabeni, Mulaudzi, Isaac, Mulaudzi, Rebecca, Mulaudzi, Mhlelekedzeni, Muligwe, Dakalo Rejoyce, Muponda, Blessing, Mushadi, Mmbangiseni Stella, Mushid, M, Muthaphuli, Konanani, Muthavhine, J, Muthika, Mpho, Mvelase, Samkelisiwe, Mvelase, Vusi, Mwehu, Laurent Kayumba, Myaka, Thabile, myburgh, Magriet, Mzamo, Zimkhitha, Mzawuziwa, Fezeka, Mzini, Mfundo Lunga, Mzizana, Oscar, Mzobe, Ntokozo, Mzobe, Thokozile, Mzobe, Zamaswazi, Mzwandile, Mtimkulu, Naby, Fathima, Naicker, Keshnee, Naicker, Pregashnie, Naicker, Saroja, Naicker, Pershen, Naicker, Saiyen Virgil, Naidoo, Ria, Naidoo, Sam, Naidoo, Mergan, Naidoo, Kamalambal, Naidoo, Aroomugam, Naku, Sivuyile, Nakwa, Firdose, Nancy, Masoga, Nathan, Rita, Naude, Maritsa, Ncaza, Gcobisa, Ncaza, Aviwe, Ncha, Relebohile, Ncoyini, Yanelisa, Ncube, Snothile, Ndaba, Mrs, Ndaba, Vusumuzi, Ndaba, Mmapula, Ndawonde, Siziwe, Ndevu, Ziphozihle, Ndhlovu, Nonhlanhla Faith, Ndima, Simphiwe, Ndlela, Sindisiwe, Ndlela, Thobsile P, Ndlovu, Nobuhle, Ndlovu, Nwabisa, Ndlovu, Virginia Dipuo, Ndlumbini, Sombekhaya, Nduli, Khululiwe, Nduli, Priscilla Nontokozo, Ndwambi, Michael, Nel, Jeremy, Nel, Rina, Nel, Lizelle, Nemanashi, Ntsundeni florah, Nemudivhiso, Usinkhangwe Nyaphophi, Nemutavhanani, Joyce Nemutavhanani, Nene, Jabu, Nene, Xolani, Netshilonga, David, Netsianda, Rendani, Newton, Charmaine, Ngalo, Vuyo Leroy, Ngani, Ncumisa, Ngcakaza, Thabisa Monica, Ngcobo, Thamela, Ngcobo, Trulove Nonhlanhla, Ngcobo, Richards, Ngcobo, Gcinile, Ngcobo, Guguletu, Ngetu, Thozama, Ngewu, Pinkie, Ngobeni, Tshepo, Ngobeni, Providence, Ngobeni, Khanyisile, Ngobeni, Prudence, Ngobese, Thembisile, Ngomane, Tracy, Ngondo, Nolusindiso, Ngubane, Nokukhanya, Ngubane, Sithembiso, Nguse, Ntombizodwa Praxedise, Ngwane, Tholakele, Ngwasheng, Elizabeth, Ngwenya, Siphamandla, Ngwenya, Gugu, Ngwenya, Nomthandazo, Ngwenya, Themba, Ngwenya, Eva, Ngxola, Zintlanu, Nhabe, Tshegofatso, Nhlabathi, Jabulile, Nhlangwana, Ishmael, Nhlapo, Sithembile, Nick, Matlala, Niemand, Vicky, Nienaber, Carina, Nix, Louise, Njikelana, Chumisa, Njomi, Masiza, Nkabinde, Lucia, NKABINDE, M, Nkabiti, Boitumelo, Nkabule, Gugu, Nkadimeng, Mankopodi, Nkanjeni, Nonkanyiso, Nkatlo, Palesa Portia, Nkewana, Bongani, Nkhwashu, Audrey, Nkoana, Ngokoana, Nkoane, Mmathapelo, Nkogatse, M, Nkomo, Fezile, Nkomo, Ntando, Nkonyane, Nontobeko, Nkosi, Sydney, Nkosi, Ntombikayise, Nkosi, Phumzile, Nkosi, Ntombifuthi, NKOSI, TINTSWALO, Nkosi, ML, Nkosi, Godfrey, Nkosi, Amukelani, Nkosi, Fikile Vinoliah, Nkosi, Mbali, Nkosi, Nomcebo Lucia, Nkosi, Siphokazi, Nkuhlu, Amanda, Nkumane, Phumzile, Nkuna, Malebo, Nkwakwha, Wendy, Noge, Sesi, Nolte, Elizabeth, Nomawabo, Peko, Nombita, Malibongwe, Nophale, Nandipha, Nothnagel, Jeanetta, Novokoza, 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Parrish, Andy, Patel, Nilesh, Pather, Anastasia, Patience, Mkhombo Tsakani, Patzke, Marisa, Pawuli, Akhumzi, Pelako, Ntandokazi, Penrose, Phaswana Sibasa, Peppeta, Litha, Pershad, Santosh, Pertunia, Makheda, Pertunia, Nkuna, Perumal, Dane, Peter, Mongameli, Peters, Justin, Petlane, Vatiswa, Petrus, Harideen, Phahladira, Kgomotso, Phakisa, Matebesi John, Phale, R, Phathela, Livhuwani, Phillip, Sekate Daniel, Phiri, Beverly, Phiri, Mapule Precious, Phokane, Thapelo, Phokoane, Frank, Pholosho, Moele, Phooko, Sekoro, Phooko, Sekodi Geoffrey, Phutiane, Maponya, Pillay, Faiza, Pillay, Melanie, Pillay, Sayuri, Pillay, C R, Plaatjie, Zikhona, Pootona, James, Potgieter, Samantha, Potgieter, Marius, Precious, Mulaudzi Mulatedzi, Pretorius, Paul Janus, Prozesky, Hans, Pule, Mokhethi, Punwasi, Jayshina, Putzier, Dot, Qankqiso, Lutho, Qebedu, Siphokazi, Qhola, Phozisa, Qotoyi, Ntombesithathu, Qotso, Sipho Victor, Qwabe, Zanele, Rabie, Helena, Rabothata, Phoebe, Rachoene, Christina, Radana, Mteteleli, Radebe, Maria, Radebe, Dr. Valentino, Radebe, Nonkululeko, Radinne, Ella, Raduvha, Sherly, Raghunath, Shamintha, Rajagopaul, Claudine, Rakgwale, Mary, Ralethe, Malumbete Michael, Ralimo, Kenneth, Ramafoko, Motlalepule, Ramagoma, Maduvhahafani, Raman, Charlotte, Ramavhuya, Dr, Rambally, Molly, Ramdeen, Nivasha, Ramdin, Tanusha, Rameshwarnath, Sharita, Ramkillawan, Yeishna, Ramotlou, Rampedi, Faith, Rampersad, Vijayluxmi, Ramuima, Avhashoni, Ranone, Noluthando, Rapasa, Mabohlale Portia, rapelang, Mpharoane, Raphaely, Nika, Rashokeng, Lesiba, Rashopola, Caroline, Ratau, Tebogo, Ratau, M, Ratshili, Mpfariseni David, Rautenbach, Elmari, Ravele, Rofhiwa, Reachable, Johannes, Rebecca, Peta Mmalahla, Reddy, Kessendri, Redfern, Andrew, Reed, Robertha, Rees, Mumsy, Reji, Dr, Reubenson, Gary, Rewthinarain, Veena, Rheeder, Paul, Rhulani, Nkonayani, Richard, Mufamadi, Rikhotso, J S, Rikhotso, Shatimone Beverley, Robert, Lavhelani Ndivhaleni, Roto, Noncedo, Ruder, Gideon, Rugnath, Kapil, Ruiters, Lizette, Ruiters, Mina, Russell, Sue, Ruwiza, Lynn, R Y, Molokoane, Saaiman, Mandy, Sabela, Emmanuel, Sadiq, Lerato, Saki, Litha, Salambwa, Hyppolite, Samjowan, Menitha, Samodien, Nazlee, Samuel, Rakgolele, Sandile, Fakudze, Sanelisiwe, Cekuse, Sani, Mandlankosi, Sawuka, Simangele, Schoeman, Lelani, Scholts, Magriet, Schroder, Ronel, Sebalabala, Mamotetekoane, Sebati, Selwalenkwe Collet, Seboko, Jacoline, Sebuthoma, Wilheminah, Segami, Annah, Segokotlo, Ruth, Sehloho, MR, Seisa, Khutjo, Sekgobela, Antony, Sekhosana, Monica, Sekonyela, John, Sekoto, Mpho, Sekulisa, Naledi, Sekwadi, Mokgadi Vanessa, Selaelo, Lebogo, Selatlha, Johannes, Selekolo, Kgomotso, Selfridge, William, Semenya, Lucy, Sengakane, Ivy, Sengata, Masabata, Sentle, Petronella, Seoketsa, Malebo, Seonandan, Pratheesha, Serumula, Thomas Mambushi, Setheni, Nkululeko, Setlale, Refiloe, Setlhodi, Tumediso, Setlhodi, Barbara, Setloghele, Robert, Sewpersad, Aarthi, Sewpersadh, Ryan, Shabalala, Phumlile, Shabangu, Owen, 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Thabelo, Nkhumeleni, Thabethe, Sibusiso, Thabo George, Lekhanya, Thare, Keorapetse, Thebogo, Makofane, Thekiso, Lerato, Theko, Lloyd, Themba, Celimphilo Zandi, Theron, Danie, Theron, Henda, Theron, Ilze, Thingathinga, Thandiwe, Thlabadira, M M, Thoka, Dikeledi, Thokwana, Zanele, Thom, Gustav, Thubakgale, Mamphot Joel, Thwala, Theodora, Thys, P, Tieho, Monethi, Timothy, Matodzi, Tintswalo, Ndlovu, Tivana, Babalwa, Tladi, Molefi, Tokota, Bongiwe, Toni, Simthandile, Torres, Ariel, Toubkin, Mande, Tsatsi, Marinda, Tshabalala, Khanyisile, Tshamase, Nozibele, Tshefu, Gontse, Tshegofatjo, Makgoga, Tshikomba, Given, Tshilo, Thapelo, Tshira, Lerato, Tshirado, S T, Tshisikule, Maipfi, Tsoke, G, TSOKE, N, Tsoko, Alatha, Tsotetsi, Mosele, Tsubella, Sandeva, Tuswa, Noxolo, Tutse, Maipato, Tutu, Nomayenzeke, Twala, Sphephelo, Twala, Nhlanhla, Twala, Simphiwe, Ubisi, John, Unathi, Tefo, Van Aswegen, A, van der Merwe, Marietjie, van der Merwe, Trudie, van der Plank, Patience, van der Spuy, Elmarie, Van Der Westhuizen, Linda, Van Der Westhuizen, Adele, van der Westhuizen, Talana, van der Westhuyzen, Mene, Van Dyk, Thea, van Heerden, Ingrid, van Jaarsveld, Ryno, Van Lill, M, van Niekerk, Heidi, van Niekerk, Ben, van Rensburg, Amanda, van Schallwyk, Judy, Van Sensie, Zeitschke Yarnrich, van Vuuren, Magda, van Vuuren, Cloete, Vandu, Olga Funiswa, Vane, Mandisa, VanZyl, Lucia, Variava, Ebrahim, Veerus, Mariam, Velapi, Nokhwezi, Veleko, Sebina, Velezantsi, Z, Venter, Retha, Vergottini, Corlia, Vermeulen, Inga, Vidah, Liabara Lufuluvhi, Vilakazi, Bongani, Vilakazi, Treasure N, Vilakazi, Mbalenhle Precious, Viljoen, Karen, Viljoen, Werner, Volschenk, Zuretha, Vos, Angelo, V V, Matlala, Walters, Jacques, Webb, Kate, Welsh, John, Wessels, D, Wheller, Judy, White, Fundile, White, Priscilla, Whyte, Carmen, Willemse, Ansie, William, Sape, Williams, Daniel, Williams, Kamielah, Williams, Mercia, Williamson, Anne, Wilson, Cherade, Wolff, Boipelo, Wray, Michelle, Xaba, Ntombizonke B, Xaba, Thabang Jabulani, Xiniwe, Thanks, Xoliswa, Mtshali, Xulu, Funokwakhe, Xulu, Gibson, Yam, Sandlakazi, Zakhura, NM, Zareloa, Mashela, Zinto, Sive, Zinziswa, Dyibeni, Ziselo, Lulamile, Zitha, Zakhele, Zitha, Emmanuel, Zokufa, Anele, Zondi, Innocent, Zondi, Sikhumbuzo Bernard, Zondi, Sbuyi, Zondi, Thulani, Zongola, Wandiswa, Zühlke, Liesl, Zulu, Zandile, Zulu, Lungelo, Zulu, Thandeka, Zulu, Slindili, Zulu, Nkosinathi, Zuma, Angel, Zungu, Precious, Zungu, Pamela, Zungu, Melusi, Zungu, Priscilla, Zwakala, Bongo Lihle, Zwane, Antonia, Zwane, Promise, Zwane, Muziwendoda, Zwane, Hlengiwe Priscila, Zwane, Nomgcobo, Jassat, Waasila, Cohen, Cheryl, Tempia, Stefano, Masha, Maureen, Goldstein, Susan, Kufa, Tendesayi, Murangandi, Pelagia, Savulescu, Dana, Walaza, Sibongile, Bam, Jamy-Lee, Davies, Mary-Ann, Prozesky, Hans W, Naude, Jonathan, Mnguni, Ayanda T, Lawrence, Charlene A, Mathema, Hlengani T, Zamparini, Jarrod, Black, John, Mehta, Ruchika, Chikobvu, Perpetual, Muvhango, Ntshengedzeni, Strydom, Riaan, Adelekan, Tsholofelo, Mdlovu, Bhekizizwe, Moodley, Nirvasha, Namavhandu, Eunice L, Venturas, Jacqueline, Magula, Nombulelo, and Blumberg, Lucille

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2021
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44. Difference in mortality among individuals admitted to hospital with COVID-19 during the first and second waves in South Africa: a cohort study

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Abdullah, Shaina, Abrahams, Fiona, Adams, Vincentius, ADNANE, FHIMA, Adoni, Sonia, Adoons, Dieketso Melitta, Africa, Veronique, Aguinaga, Dr, Akach, Susan, Alakram Khelawon, Prisha, Aldrich, George, Alesinloye, Olatunde, Aletta, Mathale Biniki, Alice, Mametja, Aphane, Tebogo, Archary, Moherndran, Arends, Felicity, Arends, Shireen, Aser, Munonde, Asmal, T, Asvat, Mohammed, Avenant, Theunis, Avhazwivhoni, Muvhali, Azuike, Magnolia, Baartman, Johanna, Babalwa, Dlava, Badenhorst, Johan, Badenhorst, Miranda Badenhorst, Badripersad (CEO), Bianca, Badul, Lalihla, Bagananeng, M, Bahle, Mncedisi, Balfour, Liezl, Baloyi, TC, Baloyi, S, Baloyi, Tinyiko, Baloyi, Tshepo Mpho, Banda, Thokozani, Barit, Shimon, Bartsch, Nicole, Bayat, Junaid, Bazana, Siyabulela, Beetge, Marlene, Bekapezulu, Nosindiso, Belebele, Rammala, Bella, Phala, Belot, Zanenkululeko, Bembe, Lindi Gladys, Bensch, Sonja, Beukes, Gishma, Bezuidenhout, Karla, Bhembe, Themba, BIKISHA, N.A, Bilenge, Ben, Bishop, Leesa, Biyela, Baphamandla, Blaauw, Cyntheola, Blaylock, Mark, Bodley, Nicola, Bogale, Power, Bokolo, Sibongile, Bolon, Stefan, Booysen, Mary, Booysen, Eldereze, Boretti, Lia, Borges, Paula, Boshoga, Millicent, Bosman, Natasha, Bosvark, Lucinda, Botes, Nicky, Botha, Adele, BOTHA, CHANTALL, Botha, Jana, BOTHA, MANDLAKAYISE IRVIN, Botha, Alet, Bradbury, Janet, Breakfast, Zandisile, Breed, Maria, Brenda, Molele, Brice, Moshito, Britz, Jolene, brown, Amanda, Buchanan, Ms T, Bucwa, Thozama, Burger, Crystelle, Busakwe, Ziyanda, Bushula, Nosiviwe, Buthelezi, Zinhle, Buthelezi, Dumsile, Buthelezi, Thubelihle, Buthelezi, Mpumelelo Basil, Buthelezi, Fundiswa Lidwina, Bux, Nadia, Buys, Christoff, Buys, Anneline, Caka, Ernestina, Canal, Armando Sanchez, Caroline, Sithole, Casper, Monrick, Cawood, Shannon, Cebisa, Oratile, Cele, Nothando, Cele, Sboniso, Cele, Sthembile Goodness, Chauke, Mkhacani, Chauke, Pinkie, Chelin, Nevil, Chen, Xiaohui, Chetty, Venmalla, Chetty, Kerisse, Cheu, Christinah, Chibabhai, Vindana, Chirima, Takudzwa, ChisaleMabotja, Mantwa, CHIVENGE, CHARITY, Choene, Ngoasheng, Choko, Mbali Nosisa, Choshi, Martin, Chowdhury, Sabbir, Christoforou, Anastacia, Chuene, S.L.S, Chueu, T.S, Cilliers, Dale, Cilliers, Vanessa, Claassen, Marcel, Cloete, Jeané, Coelho, Chantelle, Coetzee, Carol, Coetzee, Hans Jurgens, Coetzee, Christine, Coetzee, Marelize, Coetzer, Dane, Coka, Sizwe, Colane, Mr M, Combrink, Herkulaas, Conjwa, Songezo, Contrad, Colleen, Cornelissen, Faith, Cronje, Leezelle, Crouse, Christine, D.A, Moshai, D.I, Ms Mahabane, Dabi, Tshidi, Dandala, Ziyanda, Dangor, Ziyaad, Daniel, Gildenhuys, Daniel, Ngwana, Daumas, Alfred, Dauth, Madelein, David, Mongalo, Davids, Wayne, Daweti, Nozuko, Dawood, Halima, Dayile, Wandisa, DE BRUIN, B, De Klerk, Karin, De la Rosa, Tanya, de Nysschen, Marice, De vos, Marie, De Wet, Darien, Debising, Mohith, Deenadayalu, Darshan, Dekeda, Babalwa, Desiree, Mofokeng, Deysel, Annelise, Dhlamini, Abram, Diala, Makgethwa Dhlala, Diale, Mathapelo, Diketane, Bella, Dingani, Nosisa, Diniso, Siyabonga, Diphatse, Lesego, Diya, Anele, Dladla, Zihloniphile, Dladla, Nompumelelo, Dladla, Mlungisi, Dladla, Patience, Dlamini, Baphilie, DLAMINI, NONHLANHLA, Dlamini, Linda, Dlamini, Nonzwakazi, Dlamini, Wendy, Dlamini, Ncomeka, Dlamini, Siyabonga, Dlamini, Nicodemus, Dlamini, Lebohang, Dlamini, Motshedise, Dlava, Babalwa Christine, Dlova, Phikiwe, Dlozi, Lindiwe, Doreen, Maenetja, Doyi, Vumile, Doyi, Athini, Du Plessis, Belinda, du Plessis, Johanna Aletta, du Plessis, Mr. Eddie, du Plessis, Nicolette, du Plessis, Karin, du Toit, Briette, du Toit, Narissa, Dube, Jabulile, Dubula, Athayanda, Duduzile, Msomi, Duiker, Sechaba, Duma, Unati Bongile, Duma, Kholiwe, Dunne, Kella, Dyantyi, Kholeka, Dyantyi, Avile, Dyasi, Simphiwe, DYONDZO, CHAUKE, Dyubhele, Phelisa, Dywili, B.J, Edwards, Letitia Edwards, Eksteen, Madie, Ellis, Tersia, Ellis, Tia, Emmerson, Glenda, Enslin, Theusia, EPULE, ODIMULA, Erasmus, Lana, Erick, Mathonsi, Etsane, Lerato, Eunice, Shimange, Fani, Zanele, Ferreira, Mariette, Finger-Motsepe, K.L, Floris, Fabion, Fobo, Tseko, Fokotsane, Keresemetse, Fokwana, Duduzile Emmelda, Fords, Genevieve Marion, Fortein, Juanita, Fouche, Christine, Fourie, Rulandi, Frean, Andrew, Fredericks, Ludwig, Funda, Wandile, Funjwa, Kabelo, Futhane, Martha, Futuse, Amanda, Gabaediwe, Dora, Gabuza, Nonhlanhla, Galant, Janycke, Gama, Zanele, Gano, Thobile, Gardiner, Emma Cora, Gastrow, Henri, Gate, Kelly, Gaunt, Ben, Gavaza, Rikhotso, Gayi, Thapelo, Gcakasi, Nkosinathi, Gcobo, Nomusa, Geffen, Leon, Geldenhuys, S, George, Jenny, Gerber, Martha, Getyengana, Zolisa, Gigi, Nkululo, Gihwala, Radha, Gilliland, Mitchell, Gloria, Zandile, Glover, Elitia, Gokailemang, Ellen, Goosen, Suseth, Gopane, Maria, Gosa - Lufuta, Thandazile, Gosnell, Bernadett, Gouws, Sharleen, Govender, Christina, Govender, Raksha, Govender, Pearl, Govender, Sally, Govender, Roxanne, Govender, K, Govender, Mrs Savie, Govinden, Rashika, Gqabuza, Luphumlo, Gqaji, Nomthandazo, Gqetywa, Maneo, Green, Caroline, Green, Nathan, Green, Neera, Grobler, Hendrik, Groenwald, Pamela, Grootboom, Daniel, Gumede, Beatrice, Gumede, Nomonde, Gumede, Simphiwe, Gumede, Slindile, Gumede, Ntombikayise, Gumede, Zenande, Gxotiwe, Thandiswa, H.L, Makhubela, Hadebe, Nonhlanhla, Hadebe, Skhumbuzo, Halkas, Christos, Hamer, Ansie, Hamida, Ebrahim, Hammond, Juan, Haniff, Sumayia, Hare, Annelise, Hattingh, lorinda, Hendricks, Thenjiwe, Henecke, Philip-George, Henly-Smith, Brends, Herselman, Glynis, Heymans, Ansie, Heyns, Chantel, Hlabahlaba, Golekane, Hlabangwane, Lucky, Hlamarisa, Simango, Hlanzi, Ntokozo, Hlela, Hlengiwe, Hlokwe, Katlego, hlongwa, Thembinkosi, Hlongwana, Anele, Hlubi, Themba, Hobo, Tozama, Hopane, Nare Nathaniel, House, Mariska, Hudson, Catharina, Huysamen, Marinda, Indheren, Jezreen, Ingle, Samantha, Isaacs, Gavin, Isaacs, TS Thekiso, Itumeleng, Maringa, J van Rensburg, Karien, Jackson, Saloshni, Jacob, Neziswa, Jacobs, Burton, Jacobs, Tshireletso, Jacobs, Gugulethu, Jaftha, Mesadi, Jaji, Zimkhitha, Jali, Sibusiso, James, Gcobisa, January, Gillian, Jeke, Andiswa, Jeremiah, Laurent, Jeremiah, LS, Jhetam, Mubeen, John, Maureen, John, Chuene, Jola, Thandiwe, Jonas, Yolande, Jonas, Anovick, Juggernath, Amilcar, kaba, eileen, Kabo, Venetia, Kadi, Disebo, Kaizer, Karabo, Kambule, Moshaya Peter, Kapp, Lorraine, Kau, Tshepo, Keneth, Nchabeleng, Kgabi, O, Kgafela, Tebogo Audrey, Kgakgadi, Vincent, Kgaswe, Isabella, Kgathlane, Tsholofelo, Kgetha, Vuyelwa Julia, Kgomojoo, Mmaselloane, Kgoro, MR B, Kgosiemang, Christinah, Kgosiencho, Gloria, Khambula, Stephen, Khan, Ariffa, Khanare, Refemetswe, Khanyase, Ncamsile, Khanyile(Data Capturer), Nokwethemba, Kharatsi, Fillip, Khawula, Simangele, Khohlakala, Themba, Khomo, Letitia, khoza, Isabel, Khoza, Sinethemba, Khukule, Nombulelo, Khumalo, Busisiwe, Khumalo, Tracy, khumalo, Zinhle, Khumalo, Vuyelwa, Khumalo, Delisile, Khumalo, Lebohang, Khumalo, Boitumelo, Khumalo, Thuli, Khumalo, Gugu, Khuzwayo, Bongiwe, Khuzwayo, Thembhelihle, Kidson, Hennie, Kistan, Jesne, Klaas, Gugu, Klassen, Marilyn, Koeberg, Josehine, Koen, Marizel, Koena, Simphiwe, Kok, Ina, Kola, Imraan, Kolokoto, Karabo, Konar, Ramachandra, Kotsedi, Dr, Kotze, Jaline, KOUPIS CDS, MARTINS, Kritzinger, Sr Helen, Kruger, Marlize, Kruger, Henk, Kubayi, Tlangelani, Kubeka, Thabisile, Kubheka, Nonjabulo, Kubheka, Melusi, Kubheka, Sibusiso Clifford, Kubheka, Erol, Kumalo, Monica, Kunene, Thulani, Kunene, Siphilile Candy, Kunneke, Yvette, KUPA, R.P, Kutama, Rachel, Kwakwazi, Nompumelelo, Kweyama, Lwanele, Labuschagne, Maureen, Labuschagne, Marina, Lakshman, Prabha, Lamani, Lungelo, Lamani, Thembela, Langa, Naomi, Langeni, Khangelani, Langeni, Aphelele, Langeni, Nwabisa Hazel, Langeveldt, Gena, Laubscher, Anchen, Le Roux, Laetitia, Leah, Magagane, Lebea, Collen, Lebea, Sello, Lebenya, Viyella Phumla Cynthia, lebogang, Lorraine, LEBOHO, PK, Lee, Chantel, Lefakane, Kelebogile Rejoice, Legoabe, Zandile, Lekala, Patrick, Lekhoaba, Motsitsi, Lekunutu, Tanki Shadrack, Lerefolo, Galaletsang, Letebele, Mrs N, Lethoba, Tsepo Patric, Letlalo, Emission, Letlhage, Ofentse, Letshufi, D.S.V, Letsoalo, Dineo Fiona, Letsoalo, Seleka Jones, Letsoalo, Pennelope, Letwaba, Getrude, Linda, Sobekwa, Lipholo, Katleho, Litabe, Sabata, Lochan, Harsha, Lomax, Linda, Lombaard, Francina, Loots, Elmarie, Lourens, Ariana, Louw, Celeste, Louw, Rianna, Lubambo, Zikhona, Lubambo, Msebenzi Moises, Ludada, Gregory, Lukas, Michael, Lungu, Thembela, Lupindo, Nomvume, Lusenga, Emmah, Luthuli, Happiness, Luvuno, Zoleka Sylvia, M.H, Sr Gwangwa, Maarman, Mustafa, Mabaso, Buyisiwe, Mabaso, Cynthia, Mabitle, Morena, Mabogoane, Grace, Mabone, Kgakgamatso, Mabuza, Rueben, Mabuza, Velaphi, Madiseng, Mogantla, Madlala, Thobile, Madolo, Mashooase, Madonsela, Thabiso, Madubanya, Lesetsa, Maepa, Amukelani, Mafumana, Namhla, Mafumo, Caroline, Magadla, Pumeza, Magale, Viscah, Magaqa, Nompumelelo, Magda, Oberholzer, Magdeline, Rakgoale, Maggie, Tswai, Maginxa, Bongeka, Magoba, Cathrine Maite, Magongwa, Caroline, MAGUBANE, AGRETIA, Magubane, Agretia Ntombizodwa, Magwai, R, Mahabeer, Padmini, Mahadulula, Elsie, Mahanjana, Lungiswa, Maharaj, Amy, Mahlambi, Qedusiza, Mahlangu, Yvonne, Mahlangu, Lerato, Mahlangu, Ntombifikile, Mahlangu, Makhosazana, Mahlangu, Mahlatsi, Mahlasela, Penelope, Mahlatse, Thosago, Mahlobo, Regina, Mahole, Dikhing, Mahomed, Adam, Mahubane, Mapeu Debora, Mahume, Peter, Maifo, Lehlogonolo, Maimane, Vincent, Maimele, Petunia, Maine, Phakoe, Mainongwane, Patricia Senyanyathi, Majamani, Nomalungisa, Majozini, Amahle, Makalima, Noluthando, Makam, Nomfundo, Makamba, Khanyisa, Makan, R, Makarapa, Mashiane, Makgahlela, Malesela, Makgisa, Mogoiwa David, Makgomo, Makgoba, Makgopa, MA, Makhalema, Mabone, Makhanya, Lindokuhle Lizo, Makhanya, Philile Valentia, Makharaedzha, Tolerance, Makhathini, Nathi, Makhesi, Elizabeth, Makhubela, Cinile, Makhunga, Nkululeko Freedom, Makhupula, Nomalinge, Makhura, RR, Makola, Rangwato, Makuba, Zingisa, Makubalo, Asanda, Makumsha, Lonwabo, Makuya, George, Malaka, Levy Mmachuene, Malangeni, Themba, MALATJI, ML, Malebana-Metsing, Pelonomi, Malek, Malek, Malevu, Luthando, Malgas, Juanita, Malgas, Dimakatso, Malope, Paul Makgasane, Malose, Monyeki, Maluleke, Katekani, Mambane, Kato, Mamorobela, Nthabiseng, Manamela, Kukami, Manana, Tshepo, Maneto, Sathiel, Manganye, Aron Kabelo, Mangena, Pheto, Mangoale, Anna, MANGOZHO, TINOTENDA FLORENCE, Manickchund, Pariva, Mankayi, Zandisile, Manning, Arthur, Manyaapelo, Kelebogile Manyaapelo, Manyane, Tabea, Manzana, Zoliswa, Manzini, Milton, Mapasa-Dube, Busisiwe, Maphumulo, Siboniso, Maphumulo, Ntombifuthi, Maponya, Sindy, Maponya, Khomotso Mumsy, Maponya, Napjadi, Maqubela, Lami, Maqubela, Lizeka, Maqungo, Vuyo, Marais, Marisa, Marais, Chantal, Maramba, Nondumiso, Mare, Annelize, Maredi, Madumetsa, Martins, Afikile, Marule, Johanna, Marumo, Refilwe, Masakona, NN, MASEHLA, KEDIBONE VINCENTIA, Maseko, Eric, Maselesele, 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A.M., Mosana, Thabo, Mosase, Alice, Mose, Yolanda, Mosehlo, Maponya, Moseki, Mothusi, Moshabe, Mojalefa David, Moshani, Mbulelo, Moshani, Pelisa, Mosima, Ledwaba, Mosima, Ezrom, Mosoma, M.P, Motaung, Lebohang, Motaung, Mokete, Motaung Xhama, Thozama Charmain, Motha, Purine Khethiwe, Motimele, Lerato, Motimeng, Boitumelo, Motladiile, Shirley, Motlhabane, otsile, Motlhamme, Joshua, Motloba, Mandla, Motse, Kagiso, Motshegoa, Sophia, Moutlana, Edward, Mouton, Irma, Moya, Zanele, Moyake, Nomonde, MP, Maja, Mpete, Jenny, Mpfuni, Luamba Meltha, Mphahlele, Seputule Mphahlele, Mphake, Mashadi, Mphanya, Ephraim Letlhogonolo, Mphaphuli, Mashudu, Mphela, Tebogo Chwene, Mpontshane, MS, Mqotyana, Thabile, Mqungquthu, Babalwa, Msane, Noluthando Busane, Mseleku, Malusi, Msibi, Sibusiso, Msibi, Mancele, Msibi, Thulisile, Msibi, Siyabonga Linda, Msiza, Clement Nhlanhla, Msomi, Lungelo, Mtatambi, Mandlenkosi, Mthathambi, Thembisa, Mthembu, December, Mthembu, Nhlahla, Mthembu, Fezile Mbali, Mthembu, Lungiswa, Mthethwa, Nompumelelo Petunia, Mthimkhulu, Khulekani, Mthuli, Lungani Percival, Mthunzi, Ashley, Mtolo, Xolani Sydney, Mtolo, Nomonde Precious, Mtshali, Linda, Mtwa, Neliswa, Mtyobile, Fezeka, Mtyobile, Kanyisa, Mudau, Mpfariseni, Muemeleli, Magwabeni, Mulaudzi, Isaac, Mulaudzi, Rebecca, Mulaudzi, Mhlelekedzeni, Muligwe, Dakalo Rejoyce, Muponda, Blessing, Mushadi, Mmbangiseni Stella, Mushid, M, Muthaphuli, Konanani, Muthavhine, J, Muthika, Mpho, Mvelase, Samkelisiwe, Mvelase, Vusi, MWEHU, LAURENT KAYUMBA, Myaka, Thabile, myburgh, Magriet, Mzamo, Zimkhitha, Mzawuziwa, Fezeka, Mzini, Mfundo Lunga, Mzizana, Oscar, Mzobe, Ntokozo, Mzobe, Thokozile, Mzobe, Zamaswazi, Mzwandile, Mtimkulu, Naby, Fathima, NAICKER, KESHNEE, Naicker, Pregashnie, Naicker, Saroja, Naicker, Pershen, Naicker, Saiyen Virgil, NAIDOO, RIA, Naidoo, Sam, Naidoo, Mergan, NAIDOO, KAMALAMBAL, Naidoo, Aroomugam, Naku, Sivuyile, Nakwa, Firdose, Nancy, Masoga, Nathan, Rita, Naude, Maritsa, Ncaza, Gcobisa, Ncaza, 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Tholakele, Ngwasheng, Elizabeth, Ngwenya, Siphamandla, Ngwenya, Gugu, Ngwenya, Nomthandazo, Ngwenya, Themba, Ngwenya, Eva, Ngxola, Zintlanu, Nhabe, Tshegofatso, Nhlabathi, Jabulile, Nhlangwana, Ishmael, Nhlapo, Sithembile, nick, Matlala, Niemand, Vicky, Nienaber, Carina, Nix, Louise, Njikelana, Chumisa, Njomi, Masiza, Nkabinde, Lucia, NKABINDE, M, Nkabiti, Boitumelo, Nkabule, Gugu, Nkadimeng, Mankopodi, Nkanjeni, Nonkanyiso, Nkatlo, Palesa Portia, Nkewana, Bongani, Nkhwashu, Audrey, Nkoana, Ngokoana, Nkoane, Mmathapelo, Nkogatse, M, Nkomo, Fezile, Nkomo, Ntando, Nkonyane, Nontobeko, Nkosi, Sydney, Nkosi, Ntombikayise, Nkosi, Phumzile, Nkosi, Ntombifuthi, NKOSI, TINTSWALO, Nkosi, ML, Nkosi, Godfrey, Nkosi, Amukelani, Nkosi, Fikile Vinoliah, Nkosi, Mbali, Nkosi, Nomcebo Lucia, Nkosi, Siphokazi, Nkuhlu, Amanda, Nkumane, Phumzile, Nkuna, Malebo, Nkwakwha, Wendy, Noge, Sesi, Nolte, Elizabeth, Nomawabo, Peko, Nombita, Malibongwe, Nophale, Nandipha, Nothnagel, Jeanetta, Novokoza, Bongiwe, 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Parrish, Andy, Patel, Nilesh, Pather, Anastasia, Patience, Mkhombo Tsakani, Patzke, Marisa, Pawuli, Akhumzi, Pelako, Ntandokazi, Penrose, Phaswana Sibasa, Peppeta, Litha, Pershad, Santosh, Pertunia, Makheda, Pertunia, Nkuna, Perumal, Dane, Peter, Mongameli, Peters, Justin, Petlane, Vatiswa, Petrus, Harideen, Phahladira, Kgomotso, Phakisa, Matebesi John, Phale, R, Phathela, Livhuwani, Phillip, Sekate Daniel, Phiri, Beverly, Phiri, Mapule Precious, Phokane, Thapelo, Phokoane, Frank, Pholosho, Moele, Phooko, Sekoro, Phooko, Sekodi Geoffrey, Phutiane, Maponya, Pillay, Faiza, Pillay, Melanie, Pillay, Sayuri, Pillay, CR, Plaatjie, Zikhona, Pootona, James, Potgieter, Samantha, Potgieter, Marius, Precious, Mulaudzi Mulatedzi, Pretorius, Paul Janus, Prozesky, Hans, Pule, Mokhethi, Punwasi, Jayshina, Putzier, Dot, Qankqiso, Lutho, Qebedu, Siphokazi, Qhola, Phozisa, Qotoyi, Ntombesithathu, Qotso, Sipho Victor, Qwabe, Zanele, Rabie, Helena, Rabothata, Phoebe, Rachoene, Christina, Radana, 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Ruiters, Lizette, Ruiters, Mina, Russell, Sue, Ruwiza, Lynn, RY, Molokoane, Saaiman, Mandy, Sabela, Emmanuel, Sadiq, Lerato, Saki, Litha, SALAMBWA, HYPPOLITE, Samjowan, Menitha, Samodien, Nazlee, Samuel, Rakgolele, Sandile, Fakudze, Sanelisiwe, Cekuse, Sani, Mandlankosi, Sawuka, Simangele, Schoeman, Lelani, Scholts, Magriet, Schroder, Ronel, Sebalabala, Mamotetekoane, Sebati, Selwalenkwe Collet, Seboko, Jacoline, Sebuthoma, Wilheminah, Segami, Annah, Segokotlo, Ruth, Sehloho, MR, Seisa, Khutjo, Sekgobela, Antony, Sekhosana, Monica, Sekonyela, John, Sekoto, Mpho, Sekulisa, Naledi, Sekwadi, Mokgadi Vanessa, Selaelo, Lebogo, Selatlha, Johannes, Selekolo, Kgomotso, Selfridge, William, Semenya, Lucy, Sengakane, Ivy, Sengata, Masabata, Sentle, Petronella, Seoketsa, Malebo, Seonandan, Pratheesha, Serumula, Thomas Mambushi, Setheni, Nkululeko, Setlale, Refiloe, Setlhodi, Tumediso, Setlhodi, Barbara, Setloghele, Robert, Sewpersad, Aarthi, Sewpersadh, Ryan, Shabalala, Phumlile, Shabangu, Owen, 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SKHOSANA, RORISANG, Skoko, Tandiwe, Slabbert, Sunet, Smangaliso, Ntombela, Smedley, Christine, Smit, Lydia, Smit, Natassia, Smit, Lizelle, Smit, Michelle, Smith, Fasie, Smith, Lizzie, Smith, Sunell, Smith, Cassius, Smuts, Stefan, Sofe, Ayanda, Solomon, Khobane, Solomon, LJ, Sombani, chauke, SONGCA, RICHARD, Sontamo, Anga, Soorju, Supriya, Sopazi, Zubenathi, Soqasha, Brian, Sosibo, Bongiwe, Sotsaka, Ntsika, Soula, Mandy, Spoor, Simon, Stacey, Sarah, Stali, Asanda, Stephina, Mutele Mmboniseni, Steup, Myra, Steven, Sinoxolo, Stevens, AW, Stevens, Vincent, Steyn, Dewald, Steyn, Bianca, Stocks, Pat, Stolk, Henk, Stoltz, Alida, Strehlau, Renate, Stroebel, Anneke, Strydom, Loraine, Strydom, Jean-Marie, Strydom, Anton, Strydom, Ursula, Sunnyraj, Midhu, Swana, Nwabisa, Swanepoel, Winnie, Swanepoel, Suzan, Swartbooi, Elsie, Swartz, Estley Swartz, Syce, Casandra, T.E, Shihambi, Tabane, Joyce, Tabane, NE, Tawana, Mrs, Tebello, Ntene, Tembe, Siphosetu Wiseman, Terblanche, Samantha, Thabede, Ntombifuthi, Thabelo, Nkhumeleni, Thabethe, Sibusiso, Thabo George, Lekhanya, Thare, Keorapetse, Thebogo, Makofane, Thekiso, Lerato, Theko, Lloyd, Themba, Celimphilo Zandi, Theron, Danie, Theron, Henda, Theron, Ilze, Thingathinga, Thandiwe, THLABADIRA, M.M, Thoka, Dikeledi, Thokwana, Zanele, Thom, Gustav, Thubakgale, Mamphot Joel, Thwala, Theodora, Thys, P, Tieho, Monethi, Timothy, Matodzi, Tintswalo, Ndlovu, Tivana, Babalwa, Tladi, Molefi, Tokota, Bongiwe, Toni, Simthandile, Torres, Ariel, Toubkin, Mande, Tsatsi, Marinda, Tshabalala, Khanyisile, Tshamase, Nozibele, Tshefu, Gontse, Tshegofatjo, Makgoga, Tshikomba, Given, Tshilo, Thapelo, Tshira, Lerato, Tshirado, S.T, Tshisikule, Maipfi, Tsoke, G, TSOKE, N, Tsoko, Alatha, Tsotetsi, Mosele, TSUBELLA, SANDEVA, Tuswa, Noxolo, Tutse, Maipato, Tutu, Nomayenzeke, Twala, Sphephelo, Twala, Nhlanhla, Twala, Simphiwe, Ubisi, John, Unathi, Tefo, Van Aswegen, A, van der Merwe, Marietjie, van der Merwe, Trudie, van der Plank, Patience, van der Spuy, Elmarie, Van Der Westhuizen, Linda, Van Der Westhuizen, Adele, van der Westhuizen, Talana, van der Westhuyzen, Mene, Van Dyk, Thea, van Heerden, Ingrid, van Jaarsveld, Ryno, Van Lill, M, van Niekerk, Heidi, van Niekerk, Ben, van Rensburg, Amanda, van Schallwyk, Judy, Van Sensie, Zeitschke Yarnrich, van Vuuren, Magda, van Vuuren, Cloete, Vandu, Olga Funiswa, Vane, Mandisa, VanZyl, Lucia, Variava, Ebrahim, Veerus, Mariam, Velapi, Nokhwezi, Veleko, Sebina, Velezantsi, Z., Venter, Retha, Vergottini, Corlia, Vermeulen, Inga, Vidah, Liabara Lufuluvhi, Vilakazi, Bongani, Vilakazi, Treasure N, Vilakazi, Mbalenhle Precious, Viljoen, Karen, Viljoen, Werner, Volschenk, Zuretha, Vos, Angelo, VV, Matlala, Walters, Jacques, Webb, Kate, Welsh, John, WESSELS, D, Wheller, Judy, White, Fundile, White, Priscilla, Whyte, Carmen, Willemse, Ansie, William, Sape, Williams, Daniel, Williams, Kamielah, Williams, Mercia, Williamson, Anne, Wilson, Cherade, Wolff, Boipelo, Wray, Michelle, Xaba, Ntombizonke B, Xaba, Thabang Jabulani, Xiniwe, Thanks, Xoliswa, Mtshali, Xulu, Funokwakhe, Xulu, Gibson, Yam, Sandlakazi, Zakhura, NM, Zareloa, Mashela, Zinto, Sive, Zinziswa, Dyibeni, Ziselo, Lulamile, Zitha, Zakhele, Zitha, Emmanuel, Zokufa, Anele, Zondi, Innocent, Zondi, Sikhumbuzo Bernard, Zondi, Sbuyi, Zondi, Thulani, Zongola, Wandiswa, Zühlke, Liesl, Zulu, Zandile, ZULU, LUNGELO, Zulu, Thandeka, Zulu, Slindili, Zulu, Nkosinathi, Zuma, Angel, Zungu, precious, Zungu, Pamela, Zungu, Melusi, Zungu, Priscilla, Zwakala, Bongo Lihle, Zwane, Antonia, Zwane, Promise, Zwane, Muziwendoda, Zwane, Hlengiwe Priscila, Zwane, Nomgcobo, Jassat, Waasila, Mudara, Caroline, Ozougwu, Lovelyn, Tempia, Stefano, Blumberg, Lucille, Davies, Mary-Ann, Pillay, Yogan, Carter, Terence, Morewane, Ramphelane, Wolmarans, Milani, von Gottberg, Anne, Bhiman, Jinal N, Walaza, Sibongile, and Cohen, Cheryl

Published
2021
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47. The Madrid Trademark Registration System: Nigeria To Join Or Not?

Author

Ajunwo-Choko, Blessing

Subjects
Trademark (International law) -- Forecasts and trends, Market trend/market analysis, Business, international
Abstract

Introduction: Business operations are no longer territorial but have now become integrated on a global scale, birthing multinational companies globally. Consequently, these entities are no more only keen on expanding [...]

Published
2024

48. ‘Too old to test?’: A life course approach to HIV-related risk and self-testing among midlife-older adults in Malawi

Author

Cheryl Johnson, Moses Kumwenda, Jamilah Meghji, Augustine T. Choko, Mackwellings Phiri, Karin Hatzold, Rachel Baggaley, Miriam Taegtmeyer, Fern Terris-Prestholt, Nicola Desmond, and Elizabeth L. Corbett

Subjects
Life-course theory, Age stratification, Socioemotional selectivity, HIV/AIDS, HIV self-test, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Despite the aging HIV epidemic, increasing age can be associated with hesitancy to test. Addressing this gap is a critical policy concern and highlights the urgent need to identify the underlying factors, to improve knowledge of HIV-related risks as well as uptake of HIV testing and prevention services, in midlife-older adults. Methods We conducted five focus group discussions and 12 in-depth interviews between April 2013 and November 2016 among rural and urban Malawian midlife-older (≥30 years) men and women. Using a life-course theoretical framework we explored how age is enacted socially and its implications on HIV testing and sexual risk behaviours. We also explore the potential for HIV self-testing (HIVST) to be part of a broader strategy for engaging midlife-older adults in HIV testing, prevention and care. Thematic analysis was used to identify recurrent themes and variations. Results Midlife-older adults (30–74 years of age) associated their age with respectability and identified HIV as “a disease of youth” that would not affect them, with age protecting them against infidelity and sexual risk-taking. HIV testing was felt to be stigmatizing, challenging age norms, threatening social status, and implying “lack of wisdom”. These norms drove self-testing preferences at home or other locations deemed age and gender appropriate. Awareness of the potential for long-standing undiagnosed HIV to be carried forward from past relationships was minimal, as was understanding of treatment-as-prevention. These norms led to HIV testing being perceived as a threat to status by older adults, contributing to low levels of recent HIV testing compared to younger adults. Conclusions Characteristics associated with age-gender norms and social position encourage self-testing but drive poor HIV-risk perception and unacceptability of conventional HIV testing in midlife-older adults. There is an urgent need to provide targeted messages and services more appropriate to midlife-older adults in sub-Saharan Africa. HIVST which has often been highlighted as a tool for reaching young people, may be a valuable tool for engaging midlife-older age groups who may not otherwise test.

Published
2021
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49. Socio-cultural and economic barriers, and facilitators influencing men’s involvement in antenatal care including HIV testing: a qualitative study from urban Blantyre, Malawi

Author

Doreen Sakala, Moses K. Kumwenda, Donaldson F. Conserve, Bassey Ebenso, and Augustine T. Choko

Subjects
Antenatal care, HIV, HIV testing, Male involvement, Malawi, Sub-Saharan Africa, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Male partner involvement in antenatal care (ANC) is associated with positive maternal and neonatal outcomes. However, only a handful of men attend ANC with their partners. This study aimed to understand the underlying barriers and facilitators influencing men’s ANC attendance including HIV testing in Blantyre, Malawi. Methods Data were collected during a formative qualitative study of a cluster-randomised trial. Six focus group discussions (FGDs) with 42 men and women and 20 in-depth interviews (IDIs) were conducted at three primary health centres in urban Blantyre, Malawi. FGD participants were purposively sampled with IDI participants subsequently sampled after FGD participation. Thematic analysis was used to analyse the data. Results The economic requirement to provide for their families exerted pressure on men and often negatively affected their decision to attend ANC together with their pregnant partners despite obvious benefits. Peer pressure and the fear to be seen by peers queueing for services at ANC, an environment traditionally viewed as a space for women and children made men feel treated as trespassers and with some level of hostility rendering them feeling emasculated when they attend ANC. Health system problems associated with overall organization of the ANC services, which favours women created resistance among men to be involved. An association between ANC and HIV testing services discouraged men from attending ANC because of their fear of testing HIV-positive in the presence of their partners. The availability of a male friendly clinic offering a private, quick, supportive/sensitive and flexible service was considered to be an important incentive that would facilitate men’s ANC attendance. Men described compensation to cover transport and opportunity cost for attending the clinic as a motivator to attending ANC services and accepting an HIV test. Conclusion Peer and economic influences were the most influential barriers of men attending ANC and testing for HIV with their pregnant partners. Addressing these socio-economic barriers and having a male friendly clinic are promising interventions to promote male ANC attendance in this setting.

Published
2021
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50. Accuracy of and preferences for blood-based versus oral-fluid-based HIV self-testing in Malawi: a cross-sectional study.

Author

O'Reilly, Ailva, Mavhu, Webster, Neuman, Melissa, Kumwenda, Moses K., Johnson, Cheryl C., Sinjani, George, Indravudh, Pitchaya, Choko, Augustin, Hatzold, Karin, and Corbett, Elizabeth L.

Subjects
HIV testing kits, PATIENT self-monitoring, CROSS-sectional method, DIAGNOSIS of HIV infections, BLOOD products, RURAL health clinics
Abstract

Background: HIV self-testing (HIVST) can use either oral-fluid or blood-based tests. Studies have shown strong preferences for self-testing compared to facility-based services. Despite availability of low-cost blood-based HIVST options, to date, HIVST implementation in sub-Saharan Africa has largely been oral-fluid-based. We investigated whether users preferred blood-based (i.e. using blood sample derived from a finger prick) or oral fluid-based HIVST in rural and urban Malawi. Methods: At clinics providing HIV testing services (n = 2 urban; n = 2 rural), participants completed a semi-structured questionnaire capturing sociodemographic data before choosing to test using oral-fluid-based HVST, blood-based HIVST or provider-delivered testing. They also completed a self-administered questionnaire afterwards, followed by a confirmatory test using the national algorithm then appropriate referral. We used simple and multivariable logistic regression to identify factors associated with preference for oral-fluid or blood-based HIVST. Results: July to October 2018, N = 691 participants enrolled in this study. Given the choice, 98.4% (680/691) selected HIVST over provider-delivered testing. Of 680 opting for HIVST, 416 (61.2%) chose oral-fluid-based HIVST, 264 (38.8%) chose blood-based HIVST and 99.1% (674/680) reported their results appropriately. Self-testers who opted for blood-based HIVST were more likely to be male (50.3% men vs. 29.6% women, p < 0.001), attending an urban facility (43% urban vs. 34.6% rural, p = 0.025) and regular salary-earners (49.5% regular vs. 36.8% non-regular, p = 0.012). After adjustment, only sex was found to be associated with choice of self-test (adjusted OR 0.43 (95%CI: 0.3–0.61); p-value < 0.001). Among 264 reporting blood-based HIVST results, 11 (4.2%) were HIV-positive. Blood-based HIVST had sensitivity of 100% (95% CI: 71.5–100%) and specificity of 99.6% (95% CI: 97.6–100%), with 20 (7.6%) invalid results. Among 416 reporting oral-fluid-based HIVST results 18 (4.3%) were HIV-positive. Oral-fluid-based HIVST had sensitivity of 88.9% (95% CI: 65.3–98.6%) and specificity of 98.7% (95% CI: 97.1–99.6%), with no invalid results. Conclusions: Offering both blood-based and oral-fluid-based HIVST resulted in high uptake when compared directly with provider-delivered testing. Both types of self-testing achieved high accuracy among users provided with a pre-test demonstration beforehand. Policymakers and donors need to adequately plan and budget for the sensitisation and support needed to optimise the introduction of new quality-assured blood-based HIVST products. [ABSTRACT FROM AUTHOR]

Published
2024
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