R4D South Africa

STRIVE Learning Lab 6. Adolescent Research in South Africa.

Fri, 11 May 2012 02:58 GMT

Document Type: PowerPoint Presentation
Creator: MacPhail, C.; Venables, E.

Production Year: 2012

Citation: MacPhail, C.; Venables, E. STRIVE Learning Lab 6. Adolescent Research in South Africa. (2012) [1 hour, 7 min 02 sec]

Summary: An overview of adolescent work in both urban and rural areas of South Africa: economic incentives for preventive health programmes, appropriate methodological tools and intervention design. Presented by Dr Catherine MacPhail, Technical Team head on a randomised control trial of conditional cash transfers, and Dr Emilie Venables, Senior Researcher, both from the Wits Reproductive Health and HIV Institute, South Africa.

HIV Prevalence and Incidence among Sexually Active Females in Two Districts of South Africa to Determine Microbicide Trial Feasibility

Fri, 04 May 2012 07:50 GMT

Document Type: Journal Article
Creator: Nel, A.; Louw, C.; Hellstrom, E.; Braunstein, S.L.; Treadwell, I.; Marais, M.; de Villiers, M.; Hugo, J.; Paschke, I.; Andersen, C.; van de Wijgert, J.

Production Year: 2011

Citation: Nel, A.; Louw, C.; Hellstrom, E.; Braunstein, S.L.; Treadwell, I.; Marais, M.; de Villiers, M.; Hugo, J.; Paschke, I.; Andersen, C.; van de Wijgert, J. HIV Prevalence and Incidence among Sexually Active Females in Two Districts of South Africa to Determine Microbicide Trial Feasibility. PLoS ONE (2011) 6 (8) e21528. [DOI: 10.1371/journal.pone.0021528]

Summary: Background The suitability of populations of sexually active women in Madibeng (North-West Province) and Mbekweni (Western Cape), South Africa, for a Phase III vaginal microbicide trial was evaluated.

Methods Sexually active women 18–35 years not known to be HIV-positive or pregnant were tested cross-sectionally to determine HIV and pregnancy prevalence (798 in Madibeng and 800 in Mbekweni). Out of these, 299 non-pregnant, HIV-negative women were subsequently enrolled at each clinical research center in a 12-month cohort study with quarterly study visits.

Results HIV prevalence was 24% in Madibeng and 22% in Mbekweni. HIV incidence rates based on seroconversions over 12 months were 6.0/100 person-years (PY) (95% CI 3.0, 9.0) in Madibeng and 4.5/100 PY (95% CI 1.8, 7.1) in Mbekweni and those estimated by cross-sectional BED testing were 7.1/100 PY (95% CI 2.8, 11.3) in Madibeng and 5.8/100 PY (95% CI 2.0, 9.6) in Mbekweni. The 12-month pregnancy incidence rates were 4.8/100 PY (95% CI 2.2, 7.5) in Madibeng and 7.0/100 PY (95% CI 3.7, 10.3) in Mbekweni; rates decreased over time in both districts. Genital symptoms were reported very frequently, with an incidence of 46.8/100 PY (95% CI 38.5, 55.2) in Madibeng and 21.5/100 PY (95% CI 15.8, 27.3) in Mbekweni. Almost all (>99%) participants said that they would be willing to participate in a microbicide trial.

Conclusion These populations might be suitable for Phase III microbicide trials provided that HIV incidence rates over time remain sufficiently high to support endpoint-driven trials.

Policy interventions that attract nurses to rural areas: a multicountry discrete choice experiment

Fri, 04 May 2012 04:47 GMT

Document Type: Journal Article
Creator: Blaauw, D.; Erasmus, E.; Pagaiya, N.; Tangcharoensathei, V.; Mullei, K.; Mudhune, S.; Goodman, C.; English, M.; Lagarde, M.

Production Year: 2010

Citation: Blaauw, D.; Erasmus, E.; Pagaiya, N.; Tangcharoensathei, V.; Mullei, K.; Mudhune, S.; Goodman, C.; English, M.; Lagarde, M. Policy interventions that attract nurses to rural areas: a multicountry discrete choice experiment. Bulletin of the World Health Organization (2010) 88 (5) 350-356. [DOI: 10.2471/BLT.09.072918]

Summary: This paper evaluates the relative effectiveness of different policies in attracting nurses to rural areas in Kenya, South Africa and Thailand using data from a discrete choice experiment (DCE). A labelled DCE was designed to model the relative effectiveness of both financial and non-financial strategies designed to attract nurses to rural areas. Data were collected from over 300 graduating nursing students in each country. Mixed logit models were used for analysis and to predict the uptake of rural posts under different incentive combinations.

Researchers found that nurses’ preferences for different human resource policy interventions varied significantly between the three countries. In Kenya and South Africa, better educational opportunities or rural allowances would be most effective in increasing the uptake of rural posts, while in Thailand better health insurance coverage would have the greatest impact. In conclusion, DCEs can be designed to help policy-makers choose more effective interventions to address staff shortages in rural areas. Intervention packages tailored to local conditions are more likely to be effective than standardized global approaches.

Contextualizing group rape in post-apartheid South Africa

Thu, 03 May 2012 07:22 GMT

Document Type: Journal Article
Creator: Wood, K.

Production Year: 2005

Citation: Wood, K. Contextualizing group rape in post-apartheid South Africa. Culture, Health and Sexuality (2005) 7 (4) 303-317. [DOI: 10.1080/13691050500100724]

Summary: Collective male sexual violence is part of a continuum of sexual coercion in South Africa. This paper is based on long-term ethnographic work in an urban township in the former Transkei region. Drawing on intensive participant observation and interviews with young men in particular, it attempts to make sense of emergent narratives relating to streamlining, a local term for a not uncommon form of collective sexual coercion involving a group of male friends and one or more women. The paper begins with an overview of existing anthropological literature on collective male sexual violence, going on to elaborate the different scenarios associated with group sexual violence in the fieldsite. It seeks to provide a multi-layered contextualization of the phenomenon by considering prevailing gender discourses, subcultural issues pertaining to the urban tsotsi phenomenon, the rural practice of ukuthwala (bride capture), young working-class Africans' experiences of marginalization, and the complex links between political economy and violence in this setting.

South Africa talks climate

Thu, 03 May 2012 03:00 GMT

Document Type: Report
Creator: Neville, L.

Production Year: 2010

Citation: Neville, L. South Africa talks climate. BBC World Service Trust, London, UK (2010) 19 pp.

Summary: Between August and October 2009, the BBC World Service Trust’s Research and Learning Group, funded by the British Council, conducted research in South Africa to gauge public understanding of climate change. The research consisted of 16 focus group discussions with South African citizens, and 18 in-depth interviews with opinion leaders from government, religious institutions, the private sector, the media, and civil society. The overall objective was to find out what people think about climate change and to determine how to tailor communication and media strategies to support South Africa’s response to climate change. Key findings and recommendations are presented in this report. Most South Africans are aware of the phenomenon of global climate change, but their understanding of the science is patchy.

Understanding young women's risk for HIV/AIDS: Adolescent sexuality and vulnerability in rural KwaZulu/Natal

Wed, 02 May 2012 07:33 GMT

Document Type: Journal Article
Creator: Harrison, A.; Xaba, N.; Kunene, P.; Ntuli, N.

Production Year: 2001

Citation: Harrison, A.; Xaba, N.; Kunene, P.; Ntuli, N. Understanding young women's risk for HIV/AIDS: Adolescent sexuality and vulnerability in rural KwaZulu/Natal. Society in Transition (2001) 32 (1) 69-78. [DOI: 10.1080/21528586.2001.10419031]

Financing and cost-effectiveness analysis of public-private partnerships: provision of tuberculosis treatment in South Africa

Tue, 24 Apr 2012 04:49 GMT

Document Type: Journal Article
Creator: Sinanovic, E.; Kumaranayake, L.

Production Year: 2006

Citation: Sinanovic, E.; Kumaranayake, L. Financing and cost-effectiveness analysis of public-private partnerships: provision of tuberculosis treatment in South Africa. Cost Effectiveness and Resource Allocation (2006) 4: 11. [DOI: 10.1186/1478-7547-4-11]

Summary: Background Public-private partnerships (PPP) could be effective in scaling up services. We estimated cost and cost-effectiveness of different PPP arrangements in the provision of tuberculosis (TB) treatment, and the financing required for the different models from the perspective of the provincial TB programme, provider, and the patient.

Methods Two different models of TB provider partnerships are evaluated, relative to sole public provision: public-private workplace (PWP) and public-private non-government (PNP). Cost and effectiveness data were collected at six sites providing directly observed treatment (DOT). Effectiveness for a 12-month cohort of new sputum positive patients was measured using cure and treatment success rates. Provider and patient costs were estimated, and analysed according to sources of financing. Cost-effectiveness is estimated from the perspective of the provider, patient and society in terms of the cost per TB case cured and cost per case successfully treated.

Results Cost per case cured was significantly lower in PNP (US $354–446), and comparable between PWP (US $788–979) and public sites (US $700–1000). PPP models could significantly reduce costs to the patient by 64–100%. Relative to pure public sector provision and financing, expansion of PPPs could reduce government financing required per TB patient treated from $609–690 to $130–139 in PNP and $36–46 in PWP.

Conclusion There is a strong economic case for expanding PPP in TB treatment and potentially for other types of health services. Where PPPs are tailored to target groups and supported by the public sector, scaling up of effective services could occur at much lower cost than solely relying on public sector models.

Cost-effectiveness of isoniazid preventive therapy of averting tuberculosis among HIV-infected employees in South Africa: Evaluation of a randomised intervention

Tue, 24 Apr 2012 04:32 GMT

Document Type: Abstract
Creator: Kumaranayake, L.; Fielding, K.; Grant, A.; Roux, S.; Charalambous, S.; Day, J.; Churchyard, G.

Production Year: 2004

Citation: Kumaranayake, L.; Fielding, K.; Grant, A.; Roux, S.; Charalambous, S.; Day, J.; Churchyard, G. Cost-effectiveness of isoniazid preventive therapy of averting tuberculosis among HIV-infected employees in South Africa: Evaluation of a randomised intervention. Presented at XV International AIDS Conference (IAC), Bangkok, Thailand, 11-16 July, 2004. (2004) [Abstract no. TuOrD1210]

Summary: Background: Tuberculosis (TB) is the most common opportunistic infections among HIV-positive people in Africa. Although efficacious, there are several operational obstacles to implementing Isoniazid (INH) prophylaxis. This is the first study to estimate cost-effectiveness of INH prophylaxis in a routine health setting measuring actual TB cases averted among HIV individuals.

Method: HIV positive employees within a workplace health service were screened for active TB and offered INH where not contraindicated, according to a randomised incremental recruitment procedure. Financial and economic costs of implementing the intervention were estimated using retrospectively collected data and were incremental to voluntary counselling and testing services. TB cases averted were measured comparing the control and intervention periods.

Results: Of 1016 men screened for active TB, 679 started INH prophylaxis. 72% completed a 6 month course. TB incidence was reduced by 38% and 166 TB cases were averted. Screening for active TB and routine follow-up was 73% of total costs. The cost per person starting INH was US$27, excluding screening costs and $63 with screening. Cost per person completing INH prophylaxis was US$87 without screening, and US$120 with screening. Cost-effectiveness was US$353 per TB case averted. TB screening included a symptom questionnaire, chest x-rays and 2 sputum cultures. Routine monitoring included CD-4 counts. If only chest x-rays were used, the cost per TB case averted would be US$306 per TB case averted. Without routine CD-4 counts, the cost per TB case averted would be US $223.

Conclusions: INH prophylaxis can be cost-effective in routine health service settings in lower-resource settings. Screening and diagnostic monitoring can affect cost-effectiveness by up to 60%. In this setting, where average medical expenditures are US$1,736 per TB case treated and lost shifts by TB affected employees are estimated to be an additional US$410, INH prophylaxis is shown to be a significantly cost-saving intervention.

HIV and pulmonary tuberculosis: the impact goes beyond those infected with HIV

Tue, 24 Apr 2012 02:26 GMT

Document Type: Journal Article
Creator: Sonnenberg, P.; Glynn, J.R.; Fielding, K.; Murray, J.; Godfrey-Faussett, P.; Shearer, S.

Production Year: 2004

Citation: Sonnenberg, P.; Glynn, J.R.; Fielding, K.; Murray, J.; Godfrey-Faussett, P.; Shearer, S. HIV and pulmonary tuberculosis: the impact goes beyond those infected with HIV. AIDS (2004) 18 (4) 657-662.

Summary: Background: HIV infection increases the risk of tuberculosis. The HIV epidemic is also likely to have an indirect effect on the incidence of tuberculosis because of the increased number of infectious individuals in the population. This should be apparent as an increase in tuberculosis among HIV-negative individuals, but this has not previously been demonstrated directly.

Methods: A retrospective cohort study was conducted in four gold mines in South Africa, including all miners who had HIV tests in 1991-1997. Tuberculosis was detected by annual screening, contact tracing and self-presentation of symptomatic patients.

Results: The annual incidence of new pulmonary tuberculosis in the mines rose from 0.53% in 1991 to 1.0% in 1997. The HIV status was known for 23 874 miners, of whom 3371 were HIV positive on entry and 2737 seroconverted during follow-up. The incidence of tuberculosis was higher among HIV-positive miners than HIV-negative miners from 1992 onwards, and the proportion of tuberculosis attributable to HIV increased from 0% in 1991 to over 40%. The incidence of tuberculosis increased in HIV-negative miners from 1995 onwards; incidence in the late 1990s was double that in the early 1990s.

Conclusion: HIV infection has dramatically increased the incidence of tuberculosis. There was a direct increase in those who were HIV infected, but also a doubling in tuberculosis incidence in those remaining HIV negative, implying considerable ongoing Mycobacterium tuberculosis transmission. This has occurred despite active case finding and directly observed therapy, which exceeds WHO targets for cure rates. Further interventions targeted at both HIV and tuberculosis are needed.

Undiagnosed pulmonary tuberculosis deaths in rural South Africa

Tue, 24 Apr 2012 01:35 GMT

Document Type: Journal Article
Creator: Pronyk, P.M.; Kahn, K.; Hargreaves, J.R.; Tollman, S.M.; Collinson, M.; Hausler, H.P.; Porter, J.D.

Production Year: 2004

Citation: Pronyk, P.M.; Kahn, K.; Hargreaves, J.R.; Tollman, S.M.; Collinson, M.; Hausler, H.P.; Porter, J.D. Undiagnosed pulmonary tuberculosis deaths in rural South Africa. International Journal of Tuberculosis and Lung Disease (2004) 8 (6) 796-799.

Summary: This research explores death from pulmonary tuberculosis (PTB) using a verbal autopsy (VA) tool within the established Agincourt Health and Demographic Surveillance System site in South Africa's rural northeast. Previous work on active case finding in the area highlighted a modest burden of undiagnosed PTB in the community. This VA research confirms the existence of undiagnosed PTB deaths, with 13 (46%) of 28 PTB deaths among the permanent adult population (n = 38251) going undetected by the health service. There was a median duration of coughing in the community of 16 weeks among these undiagnosed PTB deaths. As most undiagnosed cases present to the health service at some point during their illness, intervention strategies to support early diagnosis at this level can only be re-emphasised by this work.