Research Articles (School of Health Systems and Public Health (SHSPH))

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Navigating health financing cliffs : a new era in global health
(Elsevier, 2025-05) Rasanathan, Kumanan; Beltran, Maylene M.; Biritwum-Nyarko, Alberta A.; Blecher, Mark S.; Dybul, Mark; Inoue, Hajime; Ohiri, Kelechi; Patcharanarumol, Walaiporn; Pillay, Yogan; Reddy, K. Srinath; Ren, Minghui; Cyrus Shroff, Zubin; Simons, Bright; Sparkes, Susan; Chalkidou, Kalipso
No abstract available.
Lessons for long-acting lenacapavir : catalysing equitable PrEP access in low-income and middle-income countries
(Elsevier, 2025) Lynch, Sharonann; Cohen, Rachel M.; Kavanagh, Matthew; Sharma, Agrata; Raphael, Yvette; Pillay, Yogan; Bekker, Linda-Gail
Despite substantial advances in biomedical HIV prevention, including long-acting injectable pre-exposure prophylaxis (PrEP) options such as cabotegravir, barriers to widespread adoption and scale-up persist in low-income and middle-income countries. Long-acting injectable lenacapavir is a potentially transformative HIV prevention tool, providing an unprecedented opportunity to accelerate progress. However, the global HIV response is under threat like never before, with drastic funding cuts undermining the gains of the past 25 years. The challenges of introducing and scaling up long-acting lenacapavir and other PrEP innovations are numerous. Without deliberate policy, programmatic, and financing interventions, new prevention technologies risk following slow adoption patterns of previous innovations, weakening a needed transformation of the HIV response. Drawing on lessons from the scale-up of antiretroviral therapy, and experience with previous biomedical prevention tools, a new ten-point framework should be adopted to accelerate individual and epidemiological impact—even at this time of extraordinary uncertainty.
Cannabis for medicine and food : a benefit vs risk critical appraisal
(Elsevier, 2024-12) Nethengwe, M.; Maphosa, Y.; Ahiante, Blessing Osemengbe; Oyenihi, A.B.
The use of cannabis for health purposes continues to gain significant attention due to the presence of important phytochemicals, chiefly, cannabidiol (CBD) and Δ-9-tetrahydrocannabinol (THC). The therapeutic potentials of CBD and THC in the management of cancer-associated chronic pain, anxiety, stress, nausea, vomiting, and weight loss are well-reported. These benefits are triggered by the intricate interactions of the cannabinoids with their receptors in the endocannabinoid system (ECS) leading to pharmacodynamic actions. Conversely, the possible physiological, psychiatric, cognition, addiction, and dependency risks, especially due to chronic intake of THC, are huge limitations in fully harnessing the clinical utility of cannabis. Here, an up-to-date critique of the potential merits and adverse effects of cannabis and cannabis-containing products is provided. A thorough knowledge of the interplay between CBD, THC, and the ECS gives deep insights that can be explored for consumer health without the attendant complications. Future directions in cannabis research must be guided by a nuanced understanding of its molecular mechanisms of action and potential risks, enabling the development of targeted and effective medical interventions. Besides, standardized regulations and comprehensive education that are backed by empirical evidence are crucial to fostering the safe and responsible use of cannabis for food or medicine.
Mental illness attitudes, service provision interest and further training preferences of clinical associates
(AOSIS, 2024-01-23) Moodley, Saiendhra Vasudevan; Wolvaardt, Jacqueline Elizabeth (Liz); Grobler, Christoffel; saiendhra.moodley@up.ac.za
BACKGROUND : Non-specialist health professionals are required to provide mental health services given the burden of disease due to mental illness. The study aimed to explore the attitudes of clinical associates towards those with mental illness as well as their interest in mental health work and additional mental health training. METHODS : A cross-sectional study design was utilised. The study population consisted of clinical associates based in South Africa. An electronic questionnaire was developed that incorporated the 16-item Mental Illness Clinicians’ Attitudes version 4 scale (MICA-4), which is scored out of 96 with higher scores indicating more stigmatising attitudes. Multivariate linear regression was used to determine factors associated with the MICA-4 score. RESULTS : The mean MICA-4 score for the 166 participants who completed all 16 questions was 37.55 (standard deviation 7.33). In multivariate analysis, the factors associated with significantly lower MICA-4 scores were falling in the 25- to 29-year-old age category and indicating that a mental health rotation formed part of the undergraduate degree. More than 80% of the participants (140/167, 83.8%) indicated an interest in mental health work. Two-thirds of the participants (111/167, 66.5%) indicated an interest in a specialisation in mental health. CONCLUSION : The mean MICA-4 score recorded for clinical associates indicates low stigma levels towards those with mental illness. Additionally, there is significant interest in working and training in mental health. CONTRIBUTION : Training programmes should take note of the contribution of a mental health rotation to a positive attitude to mental health patients. Clinical associates’ attitudes towards mental illness together with their interest in working and training in mental health suggest that they could be more widely utilised in mental health service provision.
Dietary patterns in relation to asthma and wheeze among adolescents in a South African rural community
(MDPI, 2025-03) Rathogwa-Takalani, Funzani; Mudau, Thabelo Rodney; Patrick, Sean Mark; Shirinde, Joyce; Voyi, Kuku; sean.patrick@up.ac.za
BACKGROUND : The rise of asthma prevalence in recent decades has been attributed to changes in dietary patterns, especially in developing countries. Studies have also suggested that dietary patterns play an important role in both asthma development and management. This study aimed to investigate the association between consumption of various foods and environmental factors with asthma and wheeze among adolescents. METHODS : A self-administered standardized International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was used to collect data on demographics, respiratory health, exposure to air pollution, and diet on n = 2855 adolescents residing in Vhembe District, South Africa. RESULTS: The prevalence of asthma and wheeze were 18.91% and 37.69%, respectively. Consuming various foods such as fast foods (OR = 1.41; 95% CI: 1.06-1.88), bread (OR = 0.60; 95% CI: 0.45-1.81), pasta (OR = 1.39; 95% CI: 1.06-1.84), seafood (OR = 1.79; 95% CI: 0.65-1.24), and nuts (OR = 0.85; 95% CI: 0.65-1.12) were significantly associated with asthma in the crude logistic regression analysis. Further analysis in the multiple regression model indicated a strong association of asthma with consumption of nuts (OR = 1.55; 95% CI: 1.11-2.17), seafood (OR = 1.60; 95% CI: 1.03-2.49), and cereal (OR = 0.67; 95% CI: 0.45-0.99). In relation to wheeze, consumption of meat (red) (OR = 0.77; 95% CI: 0.60-0.99) was a protective factor in the crude analysis. The multiple logistic regression model showed that, seafood (OR = 0.76; 95% CI: 0.59-0.96), fruit (OR = 0.55; 95% CI: 0.32-0.94), nuts (OR = 1.88; 95% CI: 1.50-2.66), and olive oil (OR = 1.48; 95% CI: 1.09-2.00) were significantly associated with wheeze. CONCLUSION : Diet plays a major role in respiratory health, especially in asthma and wheeze. Dietary changes may play a role in reducing the burden of asthma and other respiratory symptoms in adolescents.
Visualisation of in vivo protein synthesis during mycobacterial infection through [68Ga]Ga-DOTA-puromycin µPET/MRI
(Nature Research, 2024-08-20) Eigner, Sebastian; Kleynhans, Janke; Vera, Dennis R. Beckford; Sathekge, Mike Machaba; Henke, Katerina Eigner; Ebenhan, Thomas
Radiolabelled puromycin analogues will allow the quantification of protein synthesis through nuclear medicine-based imaging. A particularly useful application could be the non-invasive longitudinal visualisation of mycobacterial activity through direct quantification of puromycin binding. This study assesses the value of [68Ga]Ga-DOTA-puromycin in the visualisation of mycobacteria through positron emission tomography combined with magnetic resonance imaging (µPET/MRI). The radiopharmaceutical was produced by previously published and validated methods. [68Ga]Ga-DOTA-Puromycin imaging was performed on severe immunodeficient mice infected with Bacille Calmette-Guérin-derived M. Bovis (BCG). Acute and chronic infection stages were examined by µPET/MRI. A follow-up group of animals acted as controls (animals bearing S. aureus-derived infection and sterile inflammation) to assess tracer selectivity. [68Ga]Ga-DOTA-puromycin-µPET/MRI images revealed the acute, widespread infection within the right upper shoulder and armpit. Also, [68Ga]Ga-DOTA-puromycin signal sensitivity measured after a 12-week period was lower than that of [18F]FDG-PET in the same animals. A suitable correlation between normalised uptake values (NUV) and gold standard histopathological analysis confirms accurate tracer accumulation in viable bacteria. The radiopharmaceutical showed infection selectivity over inflammation but accumulated in both M. Bovis and S. Aureus, lacking pathogen specificity. Overall, [68Ga]Ga-DOTA-puromycin exhibits potential as a tool for non-invasive protein synthesis visualization, albeit without pathogen selectivity.
Vectorial drivers of malaria transmission in Jabi Tehnan district, Amhara Regional State, Ethiopia
(Nature Research, 2024-06-13) Belay, Aklilu; Asale, Abebe; Sole, Catherine L.; Kinya, Fiona; Yusuf, Abdullahi Ahmed; Torto, Baldwyn; Mutero, Clifford Maina; Tchouassi, David P.
Among the factors affecting the effectiveness of malaria control is poor knowledge of the entomologic drivers of the disease. We investigated anopheline populations as part of a baseline study to implement house screening of windows and doors as a supplementary malaria control tool towards elimination in Jabi Tehnan district, Amhara Regional State of Ethiopia. The samples were surveyed monthly using CDC light traps between June 2020 and May 2021. Mosquito trap density (< 3 mosquitoes/trap) was low, however, with a high overall Plasmodium sporozoite rate (9%; indoor = 4.3%, outdoor = 13.1%) comprising P. falciparum (88.9%) and P. vivax (11.1%). Anopheles gambiae s.l., mostly An. arabiensis, comprised > 80% of total anopheline captures and contributed ~ 42% of Plasmodium-infected mosquitoes. On the other hand, morphologically scored Anopheles funestus s.l., constituting about 6% of anopheline collections, accounted for 50% of sporozoite-infected mosquitoes. Most of the infected An. funestus s.l. specimens (86.7%) were grouped with previously unknown or undescribed Anopheles species previously implicated as a cryptic malaria vector in the western Kenyan highlands, confirming its wider geographic distribution in eastern Africa. Other species with Plasmodium infection included An. longipalpis C, An. theileri, An. demillioni, and An. nili. Cumulatively, 77.8% of the infected mosquitoes occurred outdoors. These results suggest efficient malaria parasite transmission despite the low vector densities, which has implications for effective endpoint indicators to monitor malaria control progress. Additionally, the largely outdoor infection and discovery of previously unknown and cryptic vectors suggest an increased risk of residual malaria transmission and, thus, a constraint on effective malaria prevention and control.
The impact of telomere length on prostate cancer aggressiveness, genomic instability and health disparities
(Nature Research, 2024-04-02) Huang, Ruotian; Bornman, Maria S. (Riana); Stricker, Phillip D.; Brum, Ilma Simoni; Mutambirwa, Shingai B.A.; Jaratlerdsiri, Weerachai; Hayes, Vanessa M.
The telomere repetitive TTAGGG motif at the ends of chromosomes, serves to preserve genomic integrity and chromosomal stability. In turn, genomic instability is a hallmark of cancer-implicating telomere disturbance. Prostate cancer (PCa) shows significant ancestral disparities, with men of African ancestry at the greatest risk for aggressive disease and associated genomic instability. Yet, no study has explored the role of telomere length (TL) with respect to ancestrally driven PCa health disparities. Patient- and technically-matched tumour-blood whole genome sequencing data for 179 ancestrally defined treatment naïve PCa patients (117 African, 62 European), we assessed for TL (blood and tumour) associations. We found shortened tumour TL to be associated with aggressive PCa presentation and elevated genomic instabilities, including percentage of genome alteration and copy number gains, in men of African ancestry. For European patients, tumour TL showed significant associations with PCa driver genes PTEN, TP53, MSH2, SETBP1 and DDX11L1, while shorter blood TL (< 3200 base pairs) and tumour TL (< 2861 base pairs) were correlated with higher risk for biochemical recurrence. Concurring with previous studies linking TL to PCa diagnosis and/or prognosis, for the first time we correlated TL differences with patient ancestry with important implications for future treatments targeting telomere dysfunction.
Supporting re-engagement with HIV services after treatment interruption in South Africa : a mixed method program evaluation of MSF’s Welcome Service
(Nature Research, 2024-03-27) Arendse , Kirsten D.; Walker , Caroline; Pfaff , Colin; Lebelo , Keitumetse; Cassidy, Tali; Isaakidis , Petros; Von der Heyden, Erin; Abdullah, Fareed; Ellman , Tom; Katz , Ingrid T.; Euvrard, Jonathan; Keene, Claire M.
Psychosocial challenges impact patients' ability to remain on antiretroviral therapy lifelong, magnified by disorganized health-systems and healthcare worker (HCW) attitudes. To address this, Médecins Sans Frontières and the Department of Health developed the Welcome Service intervention, to provide person-centered care at re-engagement after HIV treatment interruption. Implemented in Khayelitsha, South Africa, between August 2020 and February 2021, the intervention aimed to reorganize triage, optimize clinical and counselling services and address HCW attitudes. The study used a mixed-methods design, incorporating in-depth interviews, and analyses of programmatic and routine health data. Interviews demonstrated positive patient care experiences. HCWs understood the potential impact of attitudes on patient engagement, however, some continued to demonstrate judgmental attitude. Clinical objectives were variably met at re-engagement: 98% were re-initiated the same day, 50% had a CD4 done, and 45% received tuberculosis prevention. Nevertheless, 4-month retention was 66%, and 88% had a VL < 1000 c/mL. Despite HCWs' understanding of person-centered care not translating into supportive behaviors, patients had positive care experiences and the intervention ended with a high rate of VL suppression. More efforts are needed to design interventions building on Welcome Service principles to provide person-centered care and sustain retention after re-engagement.
Prevalence of and factors associated with HIV testing among adolescent girls and young women in South Africa : evidence from the South Africa demographic and health survey 2016
(South African Medical Association NPC, 2024-06) Manamela, M.F.; Musekiwa, Alfred; Twabi, Halima Sumayya; u15336132@tuks.co.za
BACKGROUND : Adolescent girls and young women (AGYW) remain vulnerable to HIV, with a higher incidence rate than their male counterparts. OBJECTIVES : To determine the prevalence of and factors associated with HIV testing among AGYW in South Africa (SA). METHODS : A cross-sectional design was used to analyse the South Africa Demographic and Health Survey 2016. Only sexually active AGYW aged 15 - 24 years residing in SA at the time of the survey were included. Descriptive statistics were used to analyse baseline sociodemographic characteristics. Univariate and multivariate logistic regression models were used to determine factors associated with HIV testing. Statistical significance was set at p<0.05, and all analyses were adjusted using survey weights to account for unequal selection probabilities. RESULTS : The overall prevalence of HIV testing among sexually active AGYW was 85.2% (95% confidence interval (CI) 83.0 - 87.1). The AGYW who had a history of pregnancy (adjusted odds ratio (aOR) 4.47; 95% CI 2.90 - 6.89), were employed (aOR 3.29; 95% CI 1.75 - 6.21), belonged to a middle wealth index (aOR 1.80; 95% CI 1.04 - 3.10), had knowledge about mother-to-child transmission of HIV (aOR 3.29; 95% CI 2.26 - 4.79), had visited a health facility during the past 12 months (aOR 2.93; 95% CI 2.09 - 4.10), or had secondary/tertiary education (aOR 2.04; 95% CI 1.04 - 3.99) had higher odds of HIV testing. CONCLUSION : The study identified an unmet need for HIV testing among sexually active AGYW in SA, especially adolescent girls aged 15 - 19 years. Increasing knowledge about HIV testing, adolescent-friendly services and other offsite strategies are therefore important for this particular key population.
Genomic epidemiology and immune escape of SARS-CoV-2 recombinant strains circulating in Botswana
(Elsevier, 2024-12) Choga , Wonderful T.; Gobe , Irene; Seru , Kedumetse; Maruapula, Dorcas; Ndlovu , Nokuthula S.; Zuze , Boitumelo J. L; Motshosi , Patience; Matsuru, Teko; Sabone , Phenyo; Yu , Xiaoyu; Blackard , Jason T.; San, James E.; Makhema, Joseph; Gaseitsiwe, Simani; Moyo, Sikhulile
OBJECTIVES : We characterized the molecular and mutational landscape of SARS-CoV-2 recombinant strains in Botswana. METHODS : We performed genomic, phylogenetic, and immunoinformatic analyses of 5254 near-complete genomes from 2020 to 2023. We assessed the presence of mutations of interested (MutOI) that may be associated with immune escape in silico . RESULTS : We observed a few recombinant strains in Botswana, with the majority being descendants of Omicron (XBB∗ ), except for XV and XM. Most recombinant sequences corresponded to transmission clusters. Most recombination events occurred within the receptor-binding domain (RDB) of the spike (S) protein. We identified 16 MutOI among different proteins, with the majority occurring at a very low global prevalence ( < 4.8 ×10− 5). We also observed S:Q474K, a MutOI in the RBD, that was predicted to escape human leukocyte antigen class I–mediated immune responses. Molecular surveillance is vital to inform early detection and response to potential variants with heightened immune and vaccine breakthrough properties. CONCLUSIONS : These results underscore the need for continued molecular surveillance to map the evolutionary landscape of SARS-CoV-2.
Screening for diabetic retinopathy at a health centre in South Africa : a cross-sectional study
(AOSIS, 2025-01) Zulu, Ntokozo; Piotie, Patrick Ngassa; Webb, Elizabeth M.; Maphenduka, Wezi G.; Cook, Steve; Rheeder, Paul; patrick.ngassapiotie@up.ac.za
BACKGROUND : In South Africa, screening for diabetic retinopathy (DR) is non-existent at the primary healthcare (PHC) level because of the absence of a screening programme. This leads to preventable vision loss. AIM : To describe the clinical characteristics and outcomes of eye screenings and subsequent referrals. SETTING : Laudium Community Health Centre (CHC), a PHC facility in Tshwane. METHODS : We conducted a cross-sectional study from February 2022 to August 2022. Individuals with diabetes were screened for eye complications using visual acuity testing, intraocular pressure measurement, and fundoscopy with a non-mydriatic digital fundus camera. Fundus images were analysed by an optometrist and an artificial intelligence (AI) programme. Demographic and clinical data were collected. RESULTS : A total of 120 participants were included, with the majority (60.7%) from Laudium CHC. Most participants (64.2%) were on oral agents, and 66.7% were women. The mean haemoglobin A1c (HbA1c) was 8.3%, with a median diabetes duration of 8 years. Artificial intelligence detected more glaucoma cases (17.5% vs 9.2%) and DR (23.3% vs 15.8%) compared to the optometrist. In contrast, the optometrist identified more cases of macula pathology (29.2% vs 19.2%). Participants (n = 79) were referred to an ophthalmologist for diagnosis confirmation and management. CONCLUSION : The study revealed that while DR was not highly prevalent among PHC patients with diabetes, there was a significant referral rate for other ocular complications. Artificial intelligence can enhance early detection and improve efficiency. CONTRIBUTION : The findings underscore the need to integrate diabetes eye screening programmes into PHC services for people living with diabetes.
Analytical treatment interruption among women with HIV in southern Africa who received VRC01 or placebo in the Antibody Mediated Prevention Study : ATI stakeholder engagement, implementation and early clinical data
(Wiley, 2025-06) Karuna, Shelly; Laher, Fatima; Dadabhai, Sufia; Yu, Pei-Chun; Grove, Doug; Orrell, Catherine; Makhema, Joseph; Hosseinipour, Mina C.; Mathew, Carrie-Anne; Brumskine, William; Mgodi, Nyaradzo; Andrew, Philip; Gama, Lucio; Karg, Carissa; Broder, Gail; Baepanye, Kagisho; Lucas, Jonathan; Andrasik, Michele; Takuva, Simbarashe G.; Villaran, Manuel; Takalani, Azwidihwi; Tressler, Randall; Soto-Torres, Lydia; Woodward Davis, Amanda S.; Dhai, Ames; Sanne, Ian M.; Cohen, Myron S.; Corey, Lawrence; Gray, Glenda; DeCamp, Allan C.; Bar, Katharine J.
INTRODUCTION : Antiretroviral therapy (ART) prevents and treats, but does not eradicate, HIV. Early ART initiation is associated with post-ART virologic control, particularly among African women, and anti-HIV-1 broadly neutralizing antibodies (bnAbs) may modulate immune responses to HIV. We evaluate whether early ART with or without anti-HIV-1 bnAb VRC01, present at HIV acquisition, is associated with later ART-free control in African women and we assess potential associations with observed control. METHODS : Stakeholder engagement informed analytical treatment interruption (ATI) study design and implementation. Participants who received placebo or VRC01 and acquired HIV in the Antibody Mediated Prevention efficacy trial were assessed for ATI eligibility, including HIV acquisition within 8 weeks of receiving VRC01 or placebo, followed by early ART initiation and ≥1 year of viral suppression. Participation facilitators and barriers were assessed. From May 2021 to February 2024, participants enrolled, stopped ART and received frequent viral load and CD4+ T-cell count monitoring for safety and assessment of meeting ART reinitiation criteria. RESULTS : Thirteen women enrolled from southern Africa. No ATI-related serious adverse events (AEs), HIV transmissions, pregnancies or ≥Grade 2 AEs were observed. Eight sexually transmitted infections were diagnosed in seven women during ATI. Two participants had tenofovir levels consistent with use during ATI; 2/11 (18%) who completed ATI without antiretroviral use exhibited ART-free control for ≥32 weeks. The median time to confirmed VL≥200 was 5.4 weeks (range 2.7−112). The most common ART reinitiation criterion met was virologic (n = 7). VRC01 receipt proximate to HIV acquisition was not associated with control. Controllers versus non-controllers did not differ by early post-acquisition viral load kinetics, acquired virus characteristics, or time from estimated acquisition to closest infusion or to ART initiation. CONCLUSIONS : In a safe, well-tolerated ATI, 18% of 11 African women exhibited post-intervention control. Design and implementation lessons inform future ATIs in Africa. Analyses of peri-acquisition and post-ATI host and viral characteristics can inform the development of interventions for HIV cure, prevention and treatment. CLINICAL TRIAL REGISTRATION : NCT04860323
Suspect screening of bisphenol A (BPA) structural analogues and functional alternatives in human milk from Canada and South Africa
(Springer Nature, 2025-07) Chi, Zhi Hao; Liu, Lan; Zheng, Jingyun; Tian, Lei; Chevrier, Jonathan; Bornman, Maria S. (Riana); Obida, Muvhulawa; Goodyer, Cindy Gates; Hales, Barbara F.; Bayen, Stephane
BACKGROUND : Plastic-related contaminants, such as bisphenols, can enter the maternal body and be transferred to breast milk. While common bisphenols such as bisphenol A, S, F and AF have been detected in previous studies, there is limited knowledge about the occurrence of other structurally similar compounds in human milk with potential endocrine-disrupting properties. OBJECTIVE : In this study, we investigated structural analogues and functional alternatives of bisphenol A (BPA) in 594 human milk samples collected from Canada (Montreal) and South Africa (Vhembe and Pretoria) using LC-Q-TOF-MS through suspect screening. METHODS : Suspect screening was performed using data collected from the milk samples using a customized database library (204 compounds). A retrospective semi-quantitative approach was then applied to estimate the levels of TGSA, D-8 and D-90 in human milk. RESULTS : This work revealed the presence of eleven compounds, including four compounds commonly used in thermal labels, four ultraviolet filters, and three synthetic antioxidants or metabolites. Retrospective semi-quantification of D-8, D-90 and TGSA revealed levels of up to 1.24, 1.98, and 0.72 ng/mL in milk, respectively. IMPACT STATEMENT : Several structural analogues and functional alternatives of bisphenol A were identified in human milk through non-targeted screening. Two other phenolic compounds (Irganox 1010 and BHT-COOH) were identified in human milk for the first time. This study highlights the importance of novel strategies in human milk biomonitoring to identify emerging contaminants to which breastfeeding infants are exposed.
Molecular characterization of hepatitis B virus in people living with HIV in rural and peri-urban communities in Botswana
(MDPI, 2024-07-14) Phinius, Bonolo B.; Choga , Wonderful T.; Anderson , Motswedi; Mokomane , Margaret; Gobe , Irene; Ratsoma, Tsholofelo; Phakedi , Basetsana; Mpebe , Gorata; Bhebhe , Lynnette; Gaolathe , Tendani; Mosepele, Mosepele; Makhema , Joseph; Shapiro , Roger; Lockman , Shahin; Musonda, Rosemary; Moyo, Sikhulile; Gaseitsiwe, Simani
BACKGROUND : Hepatitis B virus (HBV) sequencing data are important for monitoring HBV evolution. We aimed to molecularly characterize HBV sequences from participants with HBV surface antigen-positive (HBsAg+) serology and occult hepatitis B infection (OBI+). METHODS : We utilized archived plasma samples from people living with human immunodeficiency virus (PLWH) in Botswana. HBV DNA was sequenced, genotyped and analyzed for mutations. We compared mutations from study sequences to those from previously generated HBV sequences in Botswana. The impact of OBI-associated mutations on protein function was assessed using the Protein Variation Effect Analyzer. RESULTS : Sequencing success was higher in HBsAg+ than in OBI+ samples [86/128 (67.2%) vs. 21/71 (29.2%)]. Overall, 93.5% (100/107) of sequences were genotype A1, 2.8% (3/107) were D3 and 3.7% (4/107) were E. We identified 13 escape mutations in 18/90 (20%) sequences with HBsAg coverage, with K122R having the highest frequency. The mutational profile of current sequences differed from previous Botswana HBV sequences, suggesting possible mutational changes over time. Mutations deemed to have an impact on protein function were tpQ6H, surfaceV194A and preCW28L. CONCLUSIONS : We characterized HBV sequences from PLWH in Botswana. Escape mutations were prevalent and were not associated with OBI. Longitudinal HBV studies are needed to investigate HBV natural evolution.
Facilitators and barriers to antiretroviral therapy adherence among adolescents and young adults in Sub-Saharan Africa : a scoping review
(MDPI, 2025-06) Moyo, Enos; Moyo, Perseverance; Mangwana, Hadrian; Murewanhema, Grant; Dzinamarira, Tafadzwa
BACKGROUND : Globally, approximately 65% of adolescents undergoing antiretroviral therapy (ART) adhered to their treatment, whereas only 55% achieved viral suppression in 2023. The low rate of viral suppression is concerning, as elevated viral loads are associated with a heightened risk of opportunistic infections, progression to advanced HIV disease, increased mortality, and greater HIV transmission rates. We conducted this scoping review to identify the facilitators and barriers to ART adherence among adolescents and young adults (AYAs) in sub-Saharan Africa (SSA). METHODS : We conducted this scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) checklist. We searched for peer-reviewed articles published in English from 2014 to 2024 across the SCOPUS, ScienceDirect, PubMed, Africa Journals Online, and Google Scholar databases. Two reviewers independently selected the articles and extracted the data. We used NVivo to develop codes and categories of facilitators and barriers. RESULTS : We used 30 articles reporting on studies conducted in 13 countries in this review. The total number of participants in the studies was 12,250. Sixteen articles reported on qualitative studies, nine on quantitative studies, and five on mixed-methods studies. This scoping review identified various personal (14 articles), interpersonal and social (15 articles), healthcare system-related (9 articles), medication-related (7 articles), and economic (2 articles) factors that facilitate ART adherence among AYAs. Additionally, the scoping review also identified various personal (28 articles), interpersonal and social (13 articles), healthcare system-related (14 articles), medication-related (20 articles), school- or work-related (6 articles), and economic (14 articles) factors that hinder ART adherence among AYAs. CONCLUSIONS : Enhancing ART adherence in AYAs requires multiple strategies, including the reduction of internalized stigma, implementation of community awareness campaigns, harm reduction approaches for AYAs who misuse substances, comprehensive education on HIV, and the provision of support from school staff and leadership, alongside the adoption of differentiated service delivery (DSD), which encompasses home-based ART delivery, refills at private pharmacies, community ART distribution centers, and patient-led community ART refill groups, as well as multi-month dispensing practices.
Global health development aid initiatives and the quality of medical laboratory services in sub-Saharan : a narrative review
(Elsevier, 2025) Musuka, Hazel; Mano, Oscar; Iradukunda, Patrick Gad; Pierre, Gashema; Munyonho, Ferris Tatenda; Moyo, Enos; Dzinamarira, Tafadzwa
BACKGROUND : Medical laboratory diagnostic services play a critical role in the diagnosis, treatment, and management of diseases, forming the cornerstone of effective healthcare systems. Despite the crucial role of laboratory services, the quality and accessibility of medical laboratory services in sub-Saharan (SSA) face significant challenges. Global health development aid has been pivotal in supporting SSA laboratory services. This study aimed to examine global health development aid initiatives that have successfully enhanced the quality of medical laboratory services and the challenges and barriers to effectively improving medical laboratory services through global health development aid in SSA. METHODS : We used a narrative review study design. We searched PubMed, Web of Science and Scopus for articles published in the last 15 years. These three databases are generally considered premier databases for peer-reviewed articles in global health, public health, health systems, and biomedical sciences. The inclusion criteria for this review included research studies, reports, and grey literature. Only articles published in English from 2010 onward were considered. The analysis followed a qualitative approach, emphasizing thematic synthesis and critical interpretation. RESULTS : Forty articles were included in this study. Of these, 18 were primary research studies, 11 were reports, 7 were commentaries, and 4 were reviews. Five sub-themes from the successful global health development aid initiative themes were capacity building and training programs, infrastructure development, partnership models, policy advocacy and regulatory support, quality control and standardization of laboratory services. The sub-themes from the challenges and barrier theme were insufficient funding and resource allocation, human resource constraints, inadequate infrastructure and equipment, and political and institutional barriers. This review revealed that several factors, including financial sustainability, human resource capacity, institutional support, resilience, and effective monitoring systems, shape the sustainability of improvements in medical laboratory services in SSA. CONCLUSION : Achieving long-term sustainability requires strategies that ensure financial self-sufficiency, foster a skilled and stable workforce, and integrate laboratory services into national health frameworks.
Insights into malaria vectors-plant interaction in a dryland ecosystem
(Nature Research, 2024-09-04) Kinya , Fiona; Milugo, Trizah K.; Mutero , Clifford M.; Wondji, Charles S.; Torto, Baldwyn; Tchouassi, David P.
Improved understanding of mosquito–plant feeding interactions can reveal insights into the ecological dynamics of pathogen transmission. In wild malaria vectors Anopheles gambiae s.l. and An. funestus group surveyed in selected dryland ecosystems of Kenya, we found a low level of plant feeding (2.8%) using biochemical cold anthrone test but uncovered 14-fold (41%) higher rate via DNA barcoding targeting the chloroplast rbcL gene. Plasmodium falciparum positivity was associated with either reduced or increased total sugar levels and varied by mosquito species. Gut analysis revealed the mosquitoes to frequently feed on acacia plants (~ 89%) (mainly Vachellia tortilis) in the family Fabaceae. Chemical analysis revealed 1-octen-3-ol (29.9%) as the dominant mosquito attractant, and the sugars glucose, sucrose, fructose, talose and inositol enriched in the vegetative parts, of acacia plants. Nutritional analysis of An. longipalpis C with high plant feeding rates detected fewer sugars (glucose, talose, fructose) compared to acacia plants. These results demonstrate (i) the sensitivity of DNA barcoding to detect plant feeding in malaria vectors, (ii) Plasmodium infection status affects energetic reserves of wild anopheline vectors and (iii) nutrient content and olfactory cues likely represent potent correlates of acacia preferred as a host plant by diverse malaria vectors. The results have relevance in the development of odor-bait control strategies including attractive targeted sugar-baits.
Factors associated with neonatal sepsis among neonates admitted in Kibungo Referral Hospital, Rwanda
(Nature Research, 2024-07-10) Niyoyita , Jean Claude; Ndayisenga , Jerome; Omolo , Jared; Niyompano , Hosee; Bimenyimana, Pierre Celestin; Dzinamarira, Tafadzwa; Nsekuye , Olivier; Chavez , Isabella; Hakizayezu, Francois
More than one million neonatal deaths occur every year worldwide, of which 99% take place in low-income countries. In Rwanda, nearly 71% of neonatal deaths are preventable and among these, 10% are due to neonatal sepsis. Nevertheless, limited information exists on neonatal sepsis and its associated factors in Rwanda. The objectives of the study were to find prevalence and factors associated with neonatal sepsis among neonates admitted in Kibungo Referral Hospital, Ngoma District, Rwanda. We used a retrospective cross-sectional study design reviewing a subset of neonatal, maternal and laboratory records from Kibungo Hospital in 2017. Data were reviewed and collected from March to May, 2018. Logistic regression and odds ratios were calculated to identify the factors associated with neonatal sepsis at 95% CI, p < 0.05. Of the 972 total neonates’ medical records from 2017, we randomly selected 422 of which 12.8% (n = 54) had neonatal sepsis. When blood cultures were positive, 62% grew Klebsiella pneumoniae. Among neonates with sepsis, 38 (70%) recovered while 16 (30%) died. Neonatal sepsis was strongly associated with neonatal age less than or equal to three days (aOR: 2.769, 95% CI 1.312–5.843; p = 0.008); and gestational age less than 37 weeks (aOR: 4.149; CI 1.1878–9.167; p ≤ 0.001). Increased use of blood cultures including sensitivity testing, routine surface cultures of the neonatology and maternity wards facilities, and systematic ward cleaning are all important approaches to prevent and treat neonatal infections in additional to regular neonatal sepsis evaluations.
Accuracy of self‑collected versus healthcare worker collected specimens for diagnosing sexually transmitted infections in females : an updated systematic review and meta‑analysis
(Nature Research, 2024-05-07) Jaya, Ziningi Nobuhle; Mapanga, Witness; Dlangalala, Thobeka Nomzamo; Thembane, Nokukhanya; Kgarosi, Kabelo; Dzinamarira, Tafadzwa; Mashamba‑Thompson, Tivani Phosa; u21848522@tuks.ac.za
The use of self-collected specimens as an alternative to healthcare worker-collected specimens for diagnostic testing has gained increasing attention in recent years. This systematic review aimed to assess the diagnostic accuracy of self-collected specimens compared to healthcare worker-collected specimens across different sexually transmitted infections (STIs) including Chlamydia trachomatis (CT), human papillomavirus (HPV), Mycoplasma genitalium (MG), Neisseria gonorrhoea (NG), Treponema pallidum and Trichomonas vaginalis (TV) in females. A rigorous process was followed to screen for studies in various electronic databases. The quality of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. There were no studies on syphilis that met the criteria for inclusion in the review. A total of six studies for chlamydia, five studies for HPV, four studies for MG, and seven studies for gonorrhoea and trichomoniasis were included in the review. However, not all studies were included in the sub-group meta-analysis. The analysis revealed that self-collected specimens demonstrated comparable diagnostic accuracy to healthcare worker-collected specimens across most STIs. This indicates that the diagnostic accuracy of self-collected specimens can provide accurate results and enhance access to diagnostic testing, potentially improving healthcare service delivery. Future research should further explore the diagnostic accuracy of self-collected specimens in larger and more diverse populations.

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