Research Articles (School of Public Health)
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Item The Durban university of technology faculty of health sciences decentralized clinical training project: protocol for an Implementation study in KwaZulu-Natal, South Africa(JMIR Publications Inc., 2024) Nxumalo, Celenkosini Thembelenkosini; Pillay, Pavitra; Mchunu, Gugu GladnessBackground: The Durban university of technology (DUT) faculty of health sciences (FHS) in KwaZulu-Natal, South Africa, is embarking on a project to implement a decentralized clinical training program (DCTP). The DUT FHS DCTP project is being conducted in response to the growing demands of students requiring clinical service placements as part of work-integrated learning. The project is also geared toward responding to existing gaps in current practices related to the implementation of a DCTP, which has mainly been through traditional universities providing training to medical, optometry, occupational therapy, and physiotherapy students. In South Africa, a DCTP is yet to be implemented within the context of a university of technology; it is yet to be implemented within health science faculties that offer undergraduate health science programs in mainstream biomedicine and alternative and complementary disciplines. Objective: We aim to design, pilot, and establish an effective DCTP at the DUT FHS in KwaZulu-Natal, South Africa. Methods: Participatory action research comprising various designs-namely, appreciative inquiry, qualitative case study design, phenomenography, and descriptive qualitative study design-will be used to conduct the study. Data will be collected using individual interviews, focus group discussions, nominal group technique, consensus methodology, and narrative inquiry. Study participants will include various internal and external stakeholders of the DUT, namely, academic staff; students; key informants from universities currently using successfully established DCTPs; academic support staff; staff working in human resources, finance, procurement, and accounting; and experts in other disciplines such as engineering and information systems.Item Whole-of-community and intersectoral interventions that address alcohol-related harms: a scoping review(Taylor & Francis, 2024) Ulla Walmisley; Michelle De Jong; Asha GeorgeAlcohol harms threaten global population health, with youth particularly vulnerable. Low–and middle-income countries (LMIC) are increasingly targeted by the alcohol industry. Intersectoral and whole-of-community actions are recommended to combat alcohol harms, but there is insufficient global evidence synthesis and research examining interventions in LMIC. This paper maps existing literature on whole-of–community and intersectoral alcohol harms reduction interventions in high-income countries (HIC) and LMIC. Systematic searching and screening produced 61 articles from an initial set of 1325: HIC (n = 53), LMIC (n = 8). Data were extracted on geographic location, intersectoral action, reported outcomes, barriers, and enablers. HIC interventions most often targeted adolescents and combined community action with other components. LMIC interventions did not target adolescents or use policy, schools, alcohol outlets, or enforcement components. Programme enablers were a clear intervention focus with high political support and local level leadership, locally appropriate plans, high community motivation, community action and specific strategies for parents. Challenges were sustainability, complexity of interventions, managing participant expectations and difficulty engaging multiple sectorsItem Form and functioning: contextualising the start of the global financing facility policy processes in Burkina Faso(Taylor and Francis Ltd., 2024) Kiendrébéogo, Joël Arthu; George, Asha; Sory, OrokiaBurkina Faso joined the Global Financing Facility for Women, Children and Adolescents (GFF) in 2017 to address persistent gaps in funding for reproductive, maternal, newborn, child, and adolescent health and nutrition (RMNCAH-N). Few empirical papers deal with how global funding mechanisms, and specifically GFF, support resource mobilisation for health nationally. This study describes the policy processes of developing the GFF planning documents (the Investment Case and Project Appraisal Document) in Burkina Faso. We conducted an exploratory qualitative policy analysis. Data collection included document review (N = 74) and in-depth semi-structured interviews (N = 23). Data were analysed based on the components of the health policy triangle. There was strong national political support to RMNCAH-N interventions, and the process of drawing up the investment case (IC) and the project appraisal document was inclusive and multi-sectoral. Despite high-level policy commitments, subsequent implementation of the World Bank project, including the GFF contribution, was perceived by respondents as challenging, even after the project restructuring process occurred. These challenges were due to ongoing policy fragmentation for RMNCAH-N, navigation of differing procedures and perspectives between stakeholders in the setting up of the work, overcoming misunderstandings about the nature of the GFF, and weak institutional anchoring of the IC. Insecurity and political instability also contributed to observed delays and difficulties in implementing the commitments agreed upon. To tackle these issues, transformational and distributive leaderships should be promoted and made effectiveItem Experiences of support by unsuppressed adolescents living with HIV and their caregivers in Windhoek, Namibia: a qualitative study(Frontiers Media SA, 2024) Munyayi, Farai kevin; van Wyk, BrianAdolescents living with HIV (ALHIV) lag behind younger children and adults in the achievement of HIV care and treatment targets for HIV epidemic control. Treatment outcomes for adolescents may be influenced by their experiences with the support provided in HIV programs. We report on the experiences of virally unsuppressed adolescents and their caregivers with the current support in primary healthcare settings in Namibia. A qualitative descriptive and exploratory study was conducted in 13 public primary healthcare facilities in Windhoek, Namibia. A total of 25 in-depth interviews were conducted with unsuppressed adolescents (n = 14) and their caregivers (n = 11) between August and September 2023. The audio-recorded interviews were transcribed verbatim, and uploaded into ATLAS.ti software, and subjected to thematic content analysis. Three main support domains for the unsuppressed adolescents emerged from our analysis, namely: psychosocial, clinical and care, and socioeconomic support. The psychosocial support was delivered through peer support (teen clubs and treatment supporters) and enhanced adherence counselling mostly. The clinical and care support included implementing adolescent-friendly HIV services, differentiated service delivery approaches, and caregivers and healthcare worker care support for improved ART adherence, clinic attendance and continuous engagement in care. Socioeconomic support was provided for nutritional support, transport to access clinics, and school supplies, as well as income-generating projects. Psychosocial, clinical and care, and socioeconomic support are key elements in addressing the needs of adolescents challenged with achieving viral suppression. Health systems may benefit from whole-of-society and whole-of-government approaches to meet the needs of ALHIV that are beyond the scope of health service delivery such as nutritional, education and socioeconomic influences on both the health and well-being of ALHIV.Item Form and functioning: contextualising the start of the global financing facility policy processes in Burkina Faso(Taylor and Francis Ltd., 2024) Kiendrébéogo, Joël Arthur; George, Asha; Sory, OrokiaBurkina Faso joined the Global Financing Facility for Women, Children and Adolescents (GFF) in 2017 to address persistent gaps in funding for reproductive, maternal, newborn, child, and adolescent health and nutrition (RMNCAH-N). Few empirical papers deal with how global funding mechanisms, and specifically GFF, support resource mobilisation for health nationally. This study describes the policy processes of developing the GFF planning documents (the Investment Case and Project Appraisal Document) in Burkina Faso. We conducted an exploratory qualitative policy analysis. Data collection included document review (N = 74) and in-depth semi-structured interviews (N = 23). Data were analysed based on the components of the health policy triangle. There was strong national political support to RMNCAH-N interventions, and the process of drawing up the investment case (IC) and the project appraisal document was inclusive and multi-sectoral. Despite high-level policy commitments, subsequent implementation of the World Bank project, including the GFF contribution, was perceived by respondents as challenging, even after the project restructuring process occurred. These challenges were due to ongoing policy fragmentation for RMNCAH-N, navigation of differing procedures and perspectives between stakeholders in the setting up of the work, overcoming misunderstandings about the nature of the GFF, and weak institutional anchoring of the IC. Insecurity and political instability also contributed to observed delays and difficulties in implementing the commitments agreed upon. To tackle these issues, transformational and distributive leaderships should be promoted and made effectiveItem Dietary intake of low-income adults in South Africa: Ultra-processed food consumption a cause for concern(Cambridge University Press, 2024) Frank, Tamryn; Swart, Elizabeth Catherina; Ng, Shu WenObjective: Given the rapidly changing food environment and proliferation of ultra-processed foods (UPF) in South Africa (SA), this study aimed to critically evaluate dietary quality and adequacy of low-income adults using the nova classification system and WHO and world cancer research fund dietary guidelines. Design: Secondary household data and 1-d 24-h recalls were analysed from two cross-sectional studies conducted in 2017-2018. Foods consumed were classified according to the nova classification system. Compliance with WHO dietary guidelines and UPF consumption trends were evaluated. Setting: Three low-income areas (Langa, Khayalitsha and Mount Frere) in SA were included. Participants: In total, 2521 participants (18-50 years) were included in the study. Results: Participants had a mean energy intake of 7762 kJ/d. Most participants were within the acceptable WHO guideline range for saturated fat (80·4 %), total fat (68·1 %), Na (72·7 %) and free sugar (57·3 %). UPF comprised 39·4 % of diets among the average adult participant. Only 7·0 % of all participants met the WHO guideline for fruit and vegetables and 18·8 % met the guideline for fibre. Those within the highest quartile of share of energy from UPF consumed statistically higher amounts of dietary components to limit and were the highest energy consumers overall. Conclusions: Low-income adults living in SA are consuming insufficient protective dietary components, while UPF consumption is prevalent. Higher UPF consumers consume larger amounts of nutrients linked to increased chronic disease risk. Policy measures are urgently needed in SA to protect against the proliferation of harmful UPF and to promote and enable consumption of whole and less UPF.Item A planetary health perspective on the translation of climate change research into public health policy and practice: A scoping review protocol(Public Library of Science, 2024) Mulopo, Chanelle; Abimbola, Samuel; Onkoba, Nyamongo; Schmidt, Bey-MarrieBackground climate change (CC) emanating from anthropocentric human activities is a great threat to the quality of human life and well-being worldwide. The translation of CC research evidence can play a critical role in promoting the formulation of climate-sensitive policies to equip public health systems for CC-associated disaster preparedness, response, and management. This scoping review seeks to explore knowledge translation approaches for promoting, the uptake, and use of CC research evidence in public health policy and practice. Methods This scoping review will be conducted according to the guidelines of Arksey and O’Malley. A search strategy will be developed for published articles in PubMed, CINAHL, and Scopus databases and for grey literature in the world health organization, planetary health alliance, and the University of the Western Cape repositories. Discussion the proposed scoping review will gather existing evidence on the relationship between knowledge translation, CC research, and public health decision-making. This will provide insights into research and practice gaps, and recommendations will be made to ensure effective knowledge translation for CC related decision-making.Item Shaping the future of global access to safe, effective, appropriate and quality health products(BMJ Publishing Group, 2024) Ravinetto, Raffaella; Bradley, Hazel; Coetzee, RenierTreaties and covenants confirming the right to health would suggest that everybody is entitled to access essential diagnostic, preventive and therapeutic products.1 However, before the COVID-19 pandemic, an estimated twobillion people lacked access to essential medicines and vaccines, and most primary care facilities in low-income and middleincome countries (LMICs) lacked essential diagnostic services.2 The pandemic has widedeepened pre-existing gaps. The inequitable access to COVID-19 vaccines uncovered multiple structural problems in the organisation, financing and governance of the medical research and development (R&D) and supply ecosystem,3 encompassing unclear demand, weak distribution systems, poor donation practices and corruption, historic inequalities in access to knowledge, training and technological capabilities, lack of technology sharing and transfer, limited local production, and the absence of public health perspective in intellectual property governance. Globally, the response to the pandemic tested our world’s solidarity and brought to light continued (colonial) power dynamics that fuelled inequities, misinformation and mistrust. It also blatantly ignored lessons from the past, including the importance of gender equityItem Background commentary on the researching the obesogenic food environment (ROFE) project(PubMed Central, 2024) Annan,Reginald Adjetey; Swart,Elizabeth Catherina; Frimpomaa Agyapong,Nana AmaObjective: The objective of this commentary is to provide an overview of the rationale and objectives of the Researching the Obesogenic Food Environment (ROFE) project that was conducted in Ghana and South Africa. Design: Narration has been used to describe the main objectives, phases as well as the methods used for the conduct of this project. Setting: The project described in this commentary was conducted in Khayelitsha and Mount Frere in South Africa and Ahodwo and Ejuratia for Ghana. Participant: Participants of the study described here include households in South Africa and Ghana, stakeholders and policymakers, and various actors within the food chain in both countries. Results: The ROFE findings provide a good understanding of the extent of the impact of the food environment on consumption, characteristics of value chains of healthy and unhealthy foods, as well as the potential for improved governance and policy that is relevant to the region. The supplement provides the opportunity to share the extensive findings of the ROFE project. Nine papers that describe the process and findings of the three phases of the ROFE project have been presented. Some of the papers focus on phases of the ROFE, while others cut across different phases and explore the linkages between the phases. Briefly descriptions of key findings of some of the papers in the supplement are provided. Conclusion: Together, the findings of the ROFE study presented in this supplement have increased understanding of how communities in SA and Ghana interact with their food supplies and have led to identification of specific opportunities to improve food supply policies, in ways that create incentives for the production and consumption of healthy, relative to unhealthy foods.Item Endothelial dysfunction and cardiovascular diseases in people living with HIV on specific highly active antiretroviral therapy regimen: a systematic review of clinical studies(Elsevier Ireland Ltd, 2024) Mokoena, Haskly; Mchiza, Zandile J.; Mabhida, Sihle E.Despite the improved efficacy of highly active antiretroviral therapy (HAART) in viral suppression, emerging evidence indicates an increased burden of noncommunicable diseases in people living with HIV (PLWH). Immune activation and persistently elevated levels of inflammation have been associated with endothelial dysfunction in PLWH, likely contributing to the development of cardiovascular diseases (CVDs). Here, electronic search databases including PubMed, google scholar, Cochrane library, and Science Direct were used to retrieve scientific evidence reporting on any association between markers of endothelial function and CVD-related outcomes in PLWH on HAART. Extracted data was subjected to quality assessment using the downs and black checklist. Most (60 %) of the results indicated the presence of endothelial dysfunction in PLWH on HAART, and this was mainly through reduced flow mediated dilation and elevated serum makers of adhesion molecules like ICAM-1, VCAM-1, and P-selectin. The summarized evidence indicates an association between persistently elevated markers of endothelial dysfunction and a pro-inflammatory state in PLWH on HAART. Only a few studies reported on improved endothelial function markers in PLWH on HAART, while limited evidence is available to prove that endothelial dysfunction is associated with CVD-risk, which could be attributed to therapeutic effects of HAART. Limited studies with relatively high quality of evidence were included in this systematic review.Item Health workers’ responses to covid-19 pandemic’s impact on service delivery to adolescents in hiv treatment in cape town, south africa: a qualitative study(Multidisciplinary Digital Publishing Institute (MDPI), 2024) Mayman, Yolanda; Crowley, Talitha; van Wyk, BrianAdolescents living with HIV (ALHIVs) are considered a priority population in the fight against HIV, requiring dedicated services. The COVID-19 pandemic and subsequent disruptions deprived ALHIVs on antiretroviral therapy (ART) of the care and social support essential for treatment adherence and positive treatment outcomes. This study describes health managers’ and healthcare workers’ responses to the impact of COVID-19 on service delivery to ALHIVs in HIV treatment in the Cape Town Metropole. A descriptive qualitative design was employed, where semi-structured individual interviews (n = 13) were conducted with senior and programme managers as well as healthcare workers between April and October 2023. Inductive thematic analysis was performed using Atlas.ti version 23. Two main themes emerged from these interviews: “HIV service delivery to adolescents during the COVID-19 pandemic” and “Lessons learnt—the way forward”. The de-escalation of health services at primary health facilities and the disruption of HIV services resulted in disengagement from care by ALHIVs, increasing mental health and treatment challenges. This warrants the restoration of psychosocial support services and the re-engagement of ALHIVs. The findings from this study can function as a guide for health systems and healthcare providers to navigate future pandemics to ensure that vulnerable populations such as ALHIVs continue to receive care and treatment.Item Experiences of adolescents living with HIV on transitioning from pediatric to adult HIV care in low and middle-income countries: a qualitative evidence synthesis protocol(Public Library of Science, 2024) Petinger, Charné; Crowley, Talitha; van Wyk, BrianIn South Africa, it is estimated that approximately 320,000 adolescents living with HIV (ALHIV) will transition from pediatric to adult antiretroviral treatment (ART) by 2028. However, the age period of 10–19 years is accompanied by a myriad of barriers that challenge the transition process, and continued adherence to ART. The transition process involves ALHIV taking charge of their own health and disease management which raises challenges for their retention in care. Managing transition becomes particularly challenging in low-resource contexts as their healthcare systems are not adapted to the specific needs it requires. There is a need to garner an understanding of existing transition practices which address the specific needs of adolescents and is optimized to their requirements and available resources within a low- or middle-income country context. This review will include all qualitative and mixed method studies which will facilitate a deeper understanding the experiences of ALHIV on transition experiences. The review will specifically look at studies conducted in low- and middle-income countries. The included studies must be presented in the English language and published between 2010–2023. The search strategy will be finalized with consultation with an information specialist. All three reviewers will be present throughout all stages of the review. One reviewer will work independently on the initial screening of studies and another reviewer will assist in checks. After data is extracted, the data will be thematically analyzed with the use of Atlas.Ti computer software. No ethics approval is required and the review will be published in peer reviewed journals and submitted to conferences.Item Associations of anaemia with blood pressure in women of reproductive age: a cross-sectional study in Johannesburg, South Africa(African Field Epidemiology Network, 2024) Nxele, Xolisa; Symington, ElizabethIntroduction: South Africa has approximately 8.45 million adults living with human immunodeficiency virus (HIV) with women being higher at risk. Anaemia is proportional to HIV severity and a predictor for cardiovascular disease. In this study, we aimed to determine associations between anaemia, HIV, and blood pressure among women of childbearing age in Roodepoort, a suburb within the city of Johannesburg. Methods: in this cross-sectional study premenopausal women were recruited from a primary healthcare facility, Johannesburg. Socio-demographics, lifestyle behaviours, and medical history, including HIV status, were collected. Anthropometrical measurements and blood pressure (BP) were obtained, and venous blood was drawn to determine hemoglobin (Hb) concentration. Multiple-and logistic regression analyses were performed to determine the association between hemoglobin (Hb), HIV and blood pressure (BP). Results: of 228 women, 72% were pregnant and 22% HIV positive. Pregnant women had lower BP (SPB: 104 ± 11 vs 115 ± 11 mmHg, p<0.001; diastolic BP (DBP): 68 ± 8 vs 80±10 mmHg, p<0.001) compared to non-pregnant women. Hb levels were lower among HIV positive compared to HIV negative participants (11.4 ± 1.6 vs 12.1 ± 1.4 g/dL, p=0.010). More HIV positive women were classified as anaemic (37% vs 16%, p=0.003). In unadjusted multiple linear models, Hb concentration was associated with systolic blood pressure (SBP) (β 1.20 (95% CI, 0.28, 2.33), p=0.013) and DBP (β 1.94 (95% CI, 1.08,2.80) p <0.001), and in unadjusted logistic regression models, women with anaemia had increased odds for hypertension (OR 1.18 (95% CI, 1.20, 2.80), p=0.006). However, in both cases, significance was lost when adjusting for covariates. Conclusion: the results suggest anaemia may be a risk factor for hypertension and should be investigated in larger, homogenous samples.Item An international, multidisciplinary consensus set of patient-centered outcome measures for substance-related and addictive disorders(Multidisciplinary Digital Publishing Institute (MDPI), 2024) Black, Nicola; Florence, Maria; Chung, SophieIn 1990, the United States’ Institute of Medicine promoted the principles of outcomes monitoring in the alcohol and other drugs treatment field to improve the evidence synthesis and quality of research. While various national outcome measures have been developed and employed, no global consensus on standard measurement has been agreed for addiction. It is thus timely to build an international consensus. Convened by the International Consortium for Health Outcomes Measurement (ICHOM), an international, multi-disciplinary working group reviewed the existing literature and reached consensus for a globally applicable minimum set of outcome measures for people who seek treatment for addiction. To this end, 26 addiction experts from 11 countries and 5 continents, including people with lived experience (n = 5; 19%), convened over 16 months (December 2018–March 2020) to develop recommendations for a minimum set of outcome measures. A structured, consensus-building, modified Delphi process was employed. Evidence-based proposals for the minimum set of measures were generated and discussed across eight videoconferences and in a subsequent structured online consultation. The resulting set was reviewed by 123 professionals and 34 people with lived experience internationally.Item Access to medicines among asylum seekers, refugees and undocumented migrants across the migratory cycle in Europe: a scoping review(BMJ Publishing Group, 2024) Ravinetto, Raffaella; Aljadeeah, Saleh; Payedimarri, Anil Babu; Kielmann, KarinaIntroduction Access to essential medicines is a critical element of health systems and an important measure of their performance. Migrants may face barriers in accessing healthcare, including essential medicines, throughout the migration cycle, which includes the stages of departure from home or residence countries, transit through non-European or European countries, reception and settlement in a country in Europe and deportation. We aim to provide an overview of research and grey literature concerning access to essential medicines for asylum seekers, refugees and undocumented migrants in or heading to Europe (European Union, European Economic Area, Switzerland and the UK). Methods To delineate and conceptualise access to medicines, we considered the definition of the Lancet Commission on Essential Medicines and the Pharmaceutical Management framework. These frameworks were combined to guide several critical steps in our review, including defining the search terms, data extraction, data analyses and reporting. Relevant studies and reports were identified through searches in bibliographic and grey literature databases. Results Out of 5760 studies and 66 grey literature reports, 108 met the inclusion criteria, with 72 focusing on medicine access. Overall, medicine use and medicine expenditure were found to be lower in migrant populations compared with the host population in many European countries. Although many studies focused on the use of infectious disease and psychotropic medicines, the most frequently used medicines by migrants were analgesics, hypertension and diabetes medicines. Determinants of medicine access were legal restrictions, language and transit times, which all contributed to interruption of and inequities in access to medicines among this population. This scoping review also indicated significant gaps in the literature regarding the evidence on access to medicine at different stages of the migration cycle, specifically in departure, transit and deportation stages. Conclusion Overall, our findings highlighted significant unmet medicine needs among migrants in or on the way to Europe and access disparities attributable to various interconnected barriers. Urgent access is needed to address such inequities, particularly legal barriers, including registration of certain medicines required for treatment. Future research should prioritise investigating medicine access during departure, transit and deportation stages. Policy discussions around migrants' access to medicines should be centred on framing healthcare as a fundamental right. © Author(s) (or their employer(s)) 2024Item The HIV prevention decision-making cascade: integrating behavioural insights into hiv prevention efforts(Elsevier Inc., 2024) Knight, Lucia C.; Humphries, Hilton R.; van Heerden, Alastair C.The syndemic of HIV, sexually transmitted infections (STIs), and early pregnancy remain a key challenge to global public health. Decision-making around sexual and reproductive health (SRH) behaviours is critical to ensuring the uptake of biomedical technologies. Drawing from behavioural science theories, we propose a novel conceptual framework—the Decision Cascade—to describe the decision-making process that a user will go through as they navigate these decisions. Analogous to the HIV prevention and treatment cascade, this model describes key steps individuals go through when deciding to use HIV prevention technologies. Each step (being cued/triggered to act, reacting to the behaviour, evaluating the behaviour, assessing the feasibility of acting and the timing and final execution of the action), is influenced by a myriad of individual and socio-cultural factors, shaping the ultimate decision and behaviour outcome in a continual cycle. This framework has applications beyond HIV prevention, extending to other SRH technologies and treatments. By prioritizing human-centered design and understanding user decision-making intricacies, interventions can enhance effectiveness and address the complexities of SRH service uptake across diverse populations. The Decision Cascade framework offers a comprehensive lens to inform intervention design, emphasizing the need for nuanced approaches that resonate with the realities of decision-makers. Adopting such approaches is essential to achieving meaningful impact in HIV prevention and broader SRH initiatives.Item Assessing renal function with the use of cystatin c in a rural cohort of people living with HIV on highly active antiretroviral therapy within the Limpopo Province, South Africa(Springer Nature, 2024) Mchiza, Zandile June Rose; Choshi, Joel; Flepisi, Brian Thabile; Mabhida, Sihle EphraimThe kidneys in people living with HIV (PLWH) are constantly exposed to highly antiretroviral therapy (HAART) which may cause renal dysfunction. Cystatin C (CystC), a biomarker of renal function, is well associated with renal impairment in various populations, however, it is underexplored in the South African population of PLWH, as compared to creatinine-based measurements. Creatinine-based measurements for assessing kidney function in people with HIV can be limited due to the influence of muscle wasting, altered creatinine metabolism, and the potential for certain antiretroviral medications to impact creatinine secretion. Therefore, the current study aimed to explore the effect of HAART on renal function among PLWH with the use of Cyst C-based measures. We conducted a cross-sectional study of 111 adults PLWH, 84 on HAART, and 27 on HAART-naïve. The cluster of differentiation 4 (CD4 +) count, plasma CystC, as well as the estimated glomerular filtration rate (eGFR) using the chronic kidney disease-epidemiology collaboration (CKD-EPI) formula, were determined. In the present study, no significant differences were observed between HAART-treated and HAART-naïve groups in terms of plasma CystC and eGFRCystC.Item Community interventions for pandemic preparedness: A scoping review of pandemic preparedness lessons from HIV, COVID-19, and other public health emergencies of international concern(Public Library of Science, 2024) Hafez, Sali; Elsayed, Reem; Ismail, SharifCommunity action is broadly recognised as central to comprehensive and effective system responses to pandemics. However, there is uncertainty about how and where communities can be best supported to bolster long-term resilience and preparedness. We applied a typology of community interventions (Community Informing, Consulting, Involving, Collaborating or Empowering–or CICICE) to cover the diverse range of interventions identified across the literature and used this to structure a scoping review addressing three linked topics: (i) how CICICE interventions have been understood and applied in the literature on epidemic and pandemic preparedness; (ii) the spectrum of interventions that have been implemented to strengthen CICICE and (iii) what evidence is available on their effectiveness in influencing preparedness for current and future emergencies. We drew on peer-reviewed and grey literature from the HIV (from 2000) and COVID-19 pandemics and recent public health emergencies of international concern (from 2008), identified through systematic searches in MEDLINE, Scopus, the Cochrane Collaboration database, supplemented by keyword-structured searches in GoogleScholar and websites of relevant global health organisations.Item Kidney function in healthcare clients in Khayelitsha, South Africa: Routine laboratory testing and results reflect distinct healthcare experiences by age for healthcare clients with and without HIV(Public Library of Science, 2024) Osei-Yeboah, Richard; Tiffin, Nicki; Ngwenya, OlinaIn South Africa, PLHIV are eligible for free ART and kidney function screening. Serum creatinine (SCr) laboratory test data from the National Health Laboratory Service are collated at the Provincial Health Data Centre and linked with other routine health data. We analysed SCr and estimated glomerular filtration rate (eGFR) results for PLHIV and HIV-negative healthcare clients aged 18–80 years accessing healthcare in Khayelitsha, South Africa and comorbidity profiles at SCr and eGFR testing. 45 640 individuals aged 18–80 years with at least one renal test accessed Khayelitsha public health facilities in 2016/2017. 22 961 (50.3%) were PLHIV. Median age at first SCr and eGFR test for PLHIV was 33yrs (IQR: 27,41) to 36yrs (IQR: 30,43) compared to 49yrs (IQR: 37,57) and 52yrs (IQR: 44,59) for those without HIV. PLHIV first median SCr results were 66 (IQR: 55,78) μmol/l compared to 69 (IQR: 58,82) μmol/l for HIV-negative individuals. Hypertension, diabetes, and CKD at testing were more common in HIV-negative people than PLHIVItem Policy and programming towards addressing treatment gaps in adolescents living with HIV: A content analysis of policy and programme documents in Namibia(SAGE Publications Inc., 2024) Munyayi, Farai Kevin; van Wyk, Brian E.Adolescents living with HIV (ALHIV) face unique challenges resulting in persistent treatment gaps, particularly viral non-suppression. Country programs adopt policies, guidelines, and innovations, based on WHO recommendations and best practices from elsewhere. However, it is unclear to what extent these tools address the management of adolescents with viral non-suppression. We report on a review of guidelines for the provision of HIV services to ALHIV in Namibia. We conducted a systematic document review using Content Analysis and Thematic Analysis methodology, and the READ approach. We identified seven relevant policy documents, four of which somewhat addressed viral non-suppression (treatment gap) in ALHIV and outlined interventions to improve treatment outcomes in adolescents considering their lived experience and unique challenges. The persistent treatment gap may reflect policy implementation gaps in specifically addressing viral non-suppression. It may be worthwhile to leverage existing documents to develop specific operational guidance for ALHIV with unsuppressed viral loads.