Pick Topic
Review Topic
List Experts
Examine Expert
Save Expert
  Site Guide ··   
HIV Seropositivity: HELP
Articles from University of the Western Cape
Based on 13 articles published since 2010
||||

These are the 13 published articles about HIV Seropositivity that originated from University of the Western Cape during 2010-2020.
 
+ Citations + Abstracts
1 Article Uptake of care and treatment amongst a national cohort of HIV positive infants diagnosed at primary care level, South Africa. 2019

Mathivha, Elelwani / Olorunju, Steve / Jackson, Debra / Dinh, Thu-Ha / du Plessis, Nicolette / Goga, Ameena. ·Mamelodi Hospital, Pretoria, 0112, South Africa. · Department of Paediatrics, University of Pretoria, Pretoria, 0001, South Africa. · Biostistics Unit, South African Medical Research Council, Pretoria, 0001, South Africa. · Health Section, United Nations Children's Fund (UNICEF), New York, NY, 10017, USA. · School of Public Health, University of the Western Cape, Cape Town, 7535, South Africa. · Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA. · Department of Paediatrics, University of Pretoria, Pretoria, 0001, South Africa. Ameena.Goga@mrc.ac.za. · Health Systems Research Unit, South African Medical Research Council, Pretoria, 0001, South Africa. Ameena.Goga@mrc.ac.za. · 8 HIV Prevention Research Unit, South African Medical Research Counci, Durban, 3630, South Africa. Ameena.Goga@mrc.ac.za. ·BMC Infect Dis · Pubmed #31526376.

ABSTRACT: BACKGROUND: Loss to follow-up after a positive infant HIV diagnosis negates the potential benefits of robust policies recommending immediate triple antiretroviral therapy initiation in HIV positive infants. Whilst the diagnosis and follow-up of HIV positive infants in urban, specialized settings is easier to institutionalize, there is little information about access to care amongst HIV positive children diagnosed at primary health care clinic level. We sought to understand the characteristics of HIV positive children diagnosed with HIV infection at primary health care level, across all provinces of South Africa, their attendance at study-specific exit interviews and their reported uptake of HIV-related care. The latter could serve as a marker of knowledge, access or disclosure. METHODS: Secondary analysis of data gathered about HIV positive children, participating in an HIV-exposed infant national observational cohort study between October 2012 and September 2014, was undertaken. HIV infected children were identified by total nucleic acid polymerase chain reaction using standardized procedures in a nationally accredited central laboratory. Descriptive analyses were conducted on the HIV positive infant population, who were treated as a case series in this analysis. Data from interviews conducted at baseline (six-weeks post-delivery) and on study exit (the first visit following infant HIV positive diagnosis) were analysed. RESULTS: Of the 2878 HIV exposed infants identified at 6 weeks, 1803 (62.2%), 1709, 1673, 1660, 1680 and 1794 were see at 3, 6, 9, 12, 15 and 18 months respectively. In total, 101 tested HIV positive (67 at 6 weeks, and 34 postnatally). Most (76%) HIV positive infants were born to single mothers with a mean age of 26 years and an education level above grade 7 (76%). Although only 33.7% of pregnancies were planned, 83% of mothers reported receiving antiretroviral drugs to prevent MTCT. Of the 44 mothers with a documented recent CD4 cell count, the median was 346.8 cell/mm CONCLUSIONS: Early ART uptake amongst children aged 15 months and below was low. This raises questions about timely, early paediatric ART uptake amongst HIV positive children diagnosed in primary health care settings. Qualitative work is needed to understand low and delayed paediatric ART uptake in young children, and more work is needed to measure progress with infant ART initiation at primary care level since 2014.

2 Article Prevalence of HIV-1 drug resistance amongst newly diagnosed HIV-infected infants age 4-8 weeks, enrolled in three nationally representative PMTCT effectiveness surveys, South Africa: 2010, 2011-12 and 2012-13. 2019

Hunt, Gillian M / Ledwaba, Johanna / Salimo, Anna / Kalimashe, Monalisa / Dinh, Thu-Ha / Jackson, Debra / Sherman, Gayle / Puren, Adrian / Ngandu, Nobubelo K / Lombard, Carl / Morris, Lynn / Goga, Ameena. ·Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Services, Johannesburg, South Africa. gillianh@nicd.ac.za. · Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. gillianh@nicd.ac.za. · Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Services, Johannesburg, South Africa. · US Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV/TB, Atlanta, GA, USA. · School of Public Health, University of the Western Cape, Bellville, South Africa. · UNICEF, New York, NY, USA. · Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. · Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa. · Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa. · School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa. · Department of Paediatrics, University of Pretoria, Pretoria, South Africa. ·BMC Infect Dis · Pubmed #31526373.

ABSTRACT: BACKGROUND: South Africa (SA) has expanded efforts to reduce mother-to-child transmission of HIV (MTCT) to less than 2% at six weeks after birth and to less than 5% at 18 months postpartum by 2016. Despite improved antiretroviral regimens and coverage between 2001 and 2016, there is little data on infant HIV drug resistance. This paper tracks the prevalence of HIV drug resistance patterns amongst HIV infected infants from three nationally representative studies that assessed the effectiveness of national programs to prevent MTCT (PMTCT). The first study was conducted in 2010 (under the dual therapy PMTCT policy), the second from 2011 to 12 (PMTCT Option A policy) and the third from 2012 to 13 (PMTCT Option A policy). From 2010 to 2013, infant non-nucleoside reverse transcriptase inhibitor (NNRTI) exposure increased from single dose to daily throughout breastfeeding; maternal nucleoside reverse transcriptase inhibitor (NRTI) and NNRTI exposure increased with initiation of NNRTI-and NRTI- containing triple antiretroviral therapy (ART) earlier in gestation and at higher CD4 cell counts. METHODS: Three nationally representative surveys were conducted in 2010, 2011-12 and 2012-13. During the surveys, mothers with known, unknown, or no exposure to antiretrovirals for PMTCT and their infants were included, and MTCT was measured. For this paper, infant dried blood spots (iDBS) from HIV PCR positive infants aged 4-8 weeks, with consent for additional iDBS testing, were analysed for HIV drug resistance at the National Institute of Communicable Diseases (NICD), SA, using an in-house assay validated by the Centers for Disease Control and Prevention (CDC). Total viral nucleic acid was extracted from 2 spots and amplified by nested PCR to generate a ~ 1 kb amplicon that was sequenced using Sanger sequencing technologies. Sequence assembly and editing was performed using RECall v3. RESULTS: Overall, HIV-1 drug resistance was detected in 51% (95% Confidence interval (CI) [45-58%]) of HIV PCR positive infants, 37% (95% CI [28-47%]) in 2010, 64% (95% CI [53-74%]) in 2011 and 63% (95% CI [47-77%]) in 2012 (p < 0.0001), particularly to the NNRTI drug class. Pooled analyses across all three surveys demonstrated that infants whose mothers received ART showed the highest prevalence of resistance (74%); 26% (21/82) of HIV PCR positive infants with no or undocumented antiretroviral drug (ARV) exposure harboured NNRTI resistance. CONCLUSIONS: These data demonstrate increasing NNRTI resistance amongst newly-diagnosed infants in a high HIV prevalence setting where maternal ART coverage increased across the years, starting earlier in gestation and at higher CD4 cell counts. This is worrying as lifelong maternal ART coverage for HIV positive pregnant and lactating women is increasing. Also of concern is that resistant virus was detected in HIV positive infants whose mothers were not exposed to ARVs, raising questions about circulating resistant virus. Numbers in this group were too small to assess trends over the three years.

3 Article What will it take for the Global Plan priority countries in Sub-Saharan Africa to eliminate mother-to-child transmission of HIV? 2019

Goga, Ameena E / Dinh, Thu-Ha / Essajee, Shaffiq / Chirinda, Witness / Larsen, Anna / Mogashoa, Mary / Jackson, Debra / Cheyip, Mireille / Ngandu, Nobubelo / Modi, Surbhi / Bhardwaj, Sanjana / Chirwa, Esnat / Pillay, Yogan / Mahy, Mary. ·Health Systems Research Unit, South African Medical Research Council, Pretoria, 0001, South Africa. ameena.goga@mrc.ac.za. · HIV Prevention Research Unit, South African Medical Researh Council, Pretoria, South Africa. ameena.goga@mrc.ac.za. · Department of Paediatrics, University of Pretoria, Pretoria, 0001, South Africa. ameena.goga@mrc.ac.za. · Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA. · Department of HIV/AIDS, World Health Organisation, 27, CH-1211, Geneva, Switzerland. · Health Systems Research Unit, South African Medical Research Council, Pretoria, 0001, South Africa. · Centers for Disease Control and Prevention, Pretoria, 0001, South Africa. · Health section, United Nations Children's Fund (UNICEF), New York, 10017, USA. · School of Public Health, University of the Western Cape, Cape Town, 7535, South Africa. · Health section, UNICEF South Africa, Pretoria, 0001, South Africa. · Gender and Health Research Unit, South African Medical Research Council, Pretoria, 0001, South Africa. · School of Public Health, University of Witwatersrand, Johannesburg, 2193, South Africa. · Chief Director HIV/AIDS, TB, MCWHN, National Department of Health, Pretoria, 0001, South Africa. · Strategic Information and Evaluation Department, UNAIDS, 1211, Geneva, Switzerland. ·BMC Infect Dis · Pubmed #31526371.

ABSTRACT: BACKGROUND: The 2016 'Start Free, Stay Free, AIDS Free' global agenda, builds on the 2011-2015 'Global Plan'. It prioritises 22 countries where 90% of the world's HIV-positive pregnant women live and aims to eliminate vertical  transmission of HIV (EMTCT) and to keep mothers alive. By 2019, no Global Plan priority country had achieved EMTCT; however, 11 non-priority countries had. This paper synthesises the characteristics of the first four countries validated for EMTCT, and of the 21 Global Plan priority countries located in Sub-Saharan Africa (SSA). We consider what drives vertical transmission of HIV (MTCT) in the 21 SSA Global Plan priority countries. METHODS: A literature review, using PubMed, Science direct and the google search engine was conducted to obtain global and national-level information on current HIV-related context and health system characteristics of the first four EMTCT-validated countries and the 21 SSA Global Plan priority countries. Data representing only one clinic, hospital or region were excluded. Additionally, key global experts working on EMTCT were contacted to obtain clarification on published data. We applied three theories (the World Health Organisation's building blocks to strengthen health systems, van Olmen's Health System Dynamics framework and Baral's socio-ecological model for HIV risk) to understand and explain the differences between EMTCT-validated and non-validated countries. Additionally, structural equation modelling (SEM) and linear regression were used to explain associations between infant HIV exposure, access to antiretroviral therapy and two outcomes: (i) percent MTCT and (iii) number of new paediatric HIV infections per 100 000 live births (paediatric HIV case rate). RESULTS: EMTCT-validated countries have lower HIV prevalence, less breastfeeding, fewer challenges around leadership, governance within the health sector or country, infrastructure and service delivery compared with Global Plan priority countries. Although by 2016 EMTCT-validated countries and Global Plan priority countries had adopted a public health approach to HIV prevention, recommending lifelong antiretroviral therapy (ART) for all HIV-positive pregnant and lactating women, EMCT-validated countries had also included contact tracing such as assisted partner notification, and had integrated maternal and child health (MCH) and sexual and reproductive health (SRH) services, with services for HIV infection, sexually transmitted infections, and viral hepatitis. Additionally, Global Plan priority countries have limited data on key SRH indicators such as unmet need for family planning, with variable coverage of antenatal care, HIV testing and triple antiretroviral therapy (ART) and very limited contact tracing. Structural equation modelling (SEM) and linear regression analysis demonstrated that ART access protects against percent MTCT (p<0.001); in simple linear regression it is 53% protective against percent MTCT. In contrast, SEM demonstrated that the case rate was driven by the number of HIV exposed infants (HEI) i.e. maternal HIV prevalence (p<0.001). In linear regression models, ART access alone explains only 17% of the case rate while HEI alone explains 81% of the case rate. In multiple regression, HEI and ART access accounts for 83% of the case rate, with HEI making the most contribution (coef. infant HIV exposure=82.8, 95% CI: 64.6, 101.1, p<0.001 vs coef. ART access=-3.0, 95% CI: -6.2, 0.3, p=0.074). CONCLUSION: Reducing infant HIV exposure, is critical to reducing the paediatric HIV case rate; increasing ART access is critical to reduce percent MTCT. Additionally, our study of four validated countries underscores the importance of contact tracing, strengthening programme monitoring, leadership and governance, as these are potentially-modifiable factors.

4 Article An approach for evaluating early and long term mother-to-child transmission of HIV (MTCT) in low and middle income countries: a South African experience. 2019

Jackson, Debra J / Dinh, Thu-Ha / Lombard, Carl J / Sherman, Gayle G / Goga, Ameena E. ·School of Public Health, University of the Western Cape, Cape Town, South Africa. djackson@unicef.org. · Health Section, UNICEF, New York, NY, USA. djackson@unicef.org. · Centers for Disease Control and Prevention, Center for Global Health, Atlanta, GA, USA. · Biostatistics Unit, Medical Research Council, Cape Town, South Africa. · School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa. · Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Services, Johannesburg, South Africa. · Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa. · Health Systems Research Unit, Medical Research Council, Pretoria, South Africa. · Department of Paediatrics, University of Pretoria, Pretoria, South Africa. ·BMC Infect Dis · Pubmed #31526367.

ABSTRACT: BACKGROUND: Eliminating mother-to-child transmission of HIV is a global public health target. Robust, feasible methodologies to measure population level impact of programmes to prevent mother-to-child transmission of HIV (PMTCT) are needed in high HIV prevalence settings. We present a summary of the protocol of the South African PMTCT Evaluation (SAPMTCTE) with its revision over three repeated rounds of the survey, 2010-2014. METHODS: Three cross sectional surveys (2010, 2011-2012 and 2012-2013) were conducted in 580 primary health care immunisation service points randomly selected after stratified multistage probability proportional to size sampling. All infants aged 4-8 weeks receiving their six-week immunisation at a sampled facility on the day of the visit were eligible to participate. Trained research nurses conducted interviews and took infant dried blood spot (iDBS) samples for HIV enzyme immunoassay (EIA) and total nucleic acid polymerase chain reaction (PCR) testing. Interviews were conducted using mobile phones and iDBS were sent to the National Health Laboratory for testing. All findings were adjusted for study design, non-response, and weighted for number of South African live-birth in each study round. In 2012 a national closed cohort of these 4 to 8-week old infants testing EIA positive (HIV Exposed Infants) from the 2012-2013 cross-sectional survey was established to estimate longer-term PMTCT impact to 18 months. Follow-up analyses were to estimate weighted cumulative MTCT until 18 months, postnatal MTCT from 6 weeks until 18 months and a combined outcome of MTCT-or-death, using a competing risks model, with death as a competing risk. HIV-free survival was defined as a child surviving and HIV-negative up to 18 months or last visit seen. A weighted cumulative incidence analysis was conducted, adjusting for survey design effects. DISCUSSION: In the absence of robust high-quality routine medical recording systems, in the context of a generalised HIV epidemic, national surveys can be used to monitor PMTCT effectiveness; however, monitoring long-term outcomes nationally is difficult due to poor retention in care.

5 Article Dental development in a sample of South African HIV-positive children. 2019

Titinchi, Fadi / Behardien, Nashreen. ·Department of Maxillo-Facial and Oral Surgery, Faculty of Dentistry and WHO Collaborating Centre, University of the Western Cape, Tygerberg, South Africa. ·Spec Care Dentist · Pubmed #30648749.

ABSTRACT: AIMS: While oral soft tissue manifestations associated with HIV-infection in children are well documented, few studies have investigated the dental development of this group. The aim of this study was to assess dental development in a sample of HIV-positive children in comparison with an age-matched HIV-negative control group. METHODS AND RESULTS: The sample comprised 44 HIV-positive children and 44 HIV-negative children matched for age, gender, and ethnicity. An orthopantomograph (OPG) of each patient was assessed in order to calculate the dental age. The mineralization stages of teeth were used to calculate the dental age using tables formulated by Phillips and van Wyk-Kotze for this grouping. Results showed that dental development for both groups were similar to the dental age-related tables. HIV-positive children between 8 and 10 years of age showed significantly advanced dental development (p = 0.04). HIV-positive females showed significant advancement in dental age as compared to their chronological ages. Thirty-six (81.8%) HIV-positive children were on antiretroviral (ARV) drugs. CONCLUSION: HIV-positive children presented stages of dental development in accordance with their chronological ages and in tandem with that of the HIV-negative controls.

6 Article Structural Rearrangements Maintain the Glycan Shield of an HIV-1 Envelope Trimer After the Loss of a Glycan. 2018

Ferreira, Roux-Cil / Grant, Oliver C / Moyo, Thandeka / Dorfman, Jeffrey R / Woods, Robert J / Travers, Simon A / Wood, Natasha T. ·South African Medical Research Council Bioinformatics Unit, South African National Bioinformatics Institute, University of the Western Cape, Cape Town, South Africa. · Complex Carbohydrate Research Center, University of Georgia, Athens, Georgia, United States. · Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa. · Division of Immunology, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa. · University of Cape Town, UCT Computational Biology Group, Department of Integrated Biomedical Sciences, Institute of Infectious Disease and Molecular Medicine, Cape Town, South Africa. wood.natasha@gmail.com. ·Sci Rep · Pubmed #30302011.

ABSTRACT: The HIV-1 envelope (Env) glycoprotein is the primary target of the humoral immune response and a critical vaccine candidate. However, Env is densely glycosylated and thereby substantially protected from neutralisation. Importantly, glycan N301 shields V3 loop and CD4 binding site epitopes from neutralising antibodies. Here, we use molecular dynamics techniques to evaluate the structural rearrangements that maintain the protective qualities of the glycan shield after the loss of glycan N301. We examined a naturally occurring subtype C isolate and its N301A mutant; the mutant not only remained protected against neutralising antibodies targeting underlying epitopes, but also exhibited an increased resistance to the VRC01 class of broadly neutralising antibodies. Analysis of this mutant revealed several glycans that were responsible, independently or through synergy, for the neutralisation resistance of the mutant. These data provide detailed insight into the glycan shield's ability to compensate for the loss of a glycan, as well as the cascade of glycan movements on a protomer, starting at the point mutation, that affects the integrity of an antibody epitope located at the edge of the diminishing effect. These results present key, previously overlooked, considerations for HIV-1 Env glycan research and related vaccine studies.

7 Article The physical activity levels among people living with human immunodeficiency virus/acquired immunodeficiency syndrome receiving high active antiretroviral therapy in Rwanda. 2013

Frantz, J M / Murenzi, A. ·a PhD, is a professor in the Department of Physiotherapy at the University of the Western Cape , Private Bag x17, Bellville 7530 , South Africa. ·SAHARA J · Pubmed #24521093.

ABSTRACT: The accessibility of high active antiretroviral therapy (HAART) for local human immunodeficiency virus (HIV) patients is improving in Rwanda. It is well known that this therapy is associated with serious adverse effects, such as metabolic and morphologic changes. One of the recommended preventive modalities for these complications is participation in physical activity. The current study aims to determine the anthropometric profile and physical activity levels among people living with HIV and receiving HAART in Kigali, Rwanda. The study was a cross-sectional, descriptive quantitative survey. The participant's levels of physical activity participation and their association with anthropometric profiles were measured, using a structured self-administered questionnaire for 407 clients passing through the clinics. Of the participants, approximately 70% were inactive and in addition, 40% were obese and 43% overweight. Obesity was found to be strongly associated with inactivity. Lack of motivation, and time as well as fear of worsening the disease were found to be barriers to participation in physical activity.

8 Article Is human immunodeficiency virus (HIV) stage an independent risk factor for altering the periodontal status of HIV-positive patients? A South African study. 2013

John, Cathy Nisha / Stephen, Lawrence Xavier / Joyce Africa, Charlene Wilma. ·Anaerobe group, Department of Medical Biosciences, University of the Western Cape, Western Cape, South Africa. cafrica@uwc.ac.za. ·BMC Oral Health · Pubmed #24295071.

ABSTRACT: BACKGROUND: The immunosuppresion in HIV patients makes them highly susceptible to microbial infections. The aim of the study was to establish whether HIV stage (as depicted by CD4+ T lymphocyte counts) could independently be associated with periodontal status (as revealed by the measurement of clinical indices). METHODS: One hundred and twenty HIV-infected patients attending an infectious diseases clinic in the Western Cape, South Africa were included in the study. The periodontal clinical indices such as plaque index, gingival index, pocket probing depth and clinical attachment levels were measured on the mesial aspect of the six Ramfjord teeth. The CD4 + T cell counts were taken from the patients' medical records and patients' HIV stage determined and grouped according to their CD4+ T cell counts into A (<200 cells /mm3), B (200-500 cells /mm3) and C (>500 cells /mm3). RESULTS: The mean age of 120 HIV-positive patients was 33.25 years and the mean CD4 + T cell count was 293.43 cells/mm3. The probing depth and clinical attachment loss were found to be significantly associated with the total CD4 + T cell counts but not with HIV stage. Significant correlations were found between age and all clinical indices except for clinical attachment loss. No correlation was found between age and HIV stage of the patients. The use of antiretroviral therapy was significantly associated with probing depth and clinical attachment loss, but not with plaque nor gingival index. Significant associations were observed between smoking and all of the clinical indices except for the gingival index. A significant association was observed between the use of interdental aids and all the clinical indices except for probing depth, while brushing was significantly associated with plaque index only. CD4 + T cell counts were significantly associated with brushing frequency (p = 0.0190) and the use of interdental aids (p = 0.0170). CONCLUSION: The findings of this study conclude that HIV stage, ART and age are not independent risk factors for changes in the periodontal status of HIV-positive subjects but rather that smoking and oral hygiene habits determine their susceptibility to disease.

9 Article No association between cumulative traumatic experiences and sex in risk for posttraumatic stress disorder among human immunodeficiency virus-positive adults. 2013

Morris, Tanya / Naidoo, Pamela / Cloete, Karen J / Harvey, Justin / Seedat, Soraya. ·Department of Psychology, University of the Western Cape, Cape Town, South Africa. ·J Nerv Ment Dis · Pubmed #23689195.

ABSTRACT: This study examined the association between the type and number of traumatic experiences and the conditional risk for posttraumatic stress disorder (PTSD), stratified by sex, in human immunodeficiency virus (HIV). We evaluated 465 (114 male and 350 female) HIV-positive adults attending HIV clinics in Cape Town, South Africa. Demographic and clinical data were collected, and the participants were screened for current PTSD and traumatic event exposure using the Mini-International Neuropsychiatric Interview and the Life Events Checklist, respectively. The highest attributable risk for PTSD was derived from sexual assault (17.4%) and transport accidents (16.9%). Only sexual assault was significantly (p = 0.002) associated with current PTSD. Although sex had no effect on the prediction of current PTSD, HIV-infected men tended to experience more lifetime traumas than HIV-infected women, with the men having significantly higher rates of exposure than women to physical assault (p = 0.018) and assault with a weapon (p = 0.001). These data highlight the importance of considering trauma type in contributing to the burden of PTSD in HIV-infected adults.

10 Article Ethical and legal issues on HIV testing, policy and the practice of dentistry. 2012

Naidoo, Sudeshni / Vernillo, Anthony. ·Faculty of Dentistry and WHO Collaborating Center for Oral Health, University of the Western Cape, South Africa. suenaidoo@uwc.ac.za ·J Forensic Odontostomatol · Pubmed #23474504.

ABSTRACT: This paper is structured around the following: autonomy and consent, confidentiality, disclosure, knowledge of patient and provider HIV status, the right to choose whom to treat, testing for HIV and the importance of HIV policies in the workplace to guard against discrimination. The emergence of the HIV/AIDS pandemic has challenged traditional ethical values of the health care profession. These include the infectious nature of HIV, the social stigma of the disease and its ethical and legal dilemmas. This paper addresses some of the pertinent questions related to HIV infection and AIDS. The three broad principles of ethics, namely, autonomy, beneficence and justice, provide the basic framework on which this paper is based. Advances in the biotechnology of rapid oral fluid testing particularly in the detection of HIV antibodies from patients in the dental setting have raised additional ethical and legal considerations in the subsequent management of HIV infected patients to include disclosure of test results to the patient and proper referral to physicians or nurse practitioners. The oral health care worker must thus have a solid foundation in the application of bioethical principles. A clinical case scenario related to HIV testing in the dental setting is presented to illustrate how a lack of understanding and the wrongful application of ethical principles may lead to patient harm and legal liability. Given the increasing infection rate of HIV worldwide, polices must be upheld and revised as needed to protect healthcare providers, patients, and society generally against discrimination.

11 Article Prevalence and spectrum of head and neck lymphomas at Tygerberg Hospital, South Africa, 2003 to 2007. 2012

Chetty, M / Sudi, S / Abayomi, E A. ·University of the Western Cape, South Africa. manogari@iburst.co.za ·SADJ · Pubmed #23185941.

ABSTRACT: AIM: The aim of the study was to investigate trends of prevalence and the pathological spectrum of head and neck lymphomas (HNL) at Tygerberg Referral Hospital over five years from 2003 to 2007, and to ascertain a possible relationship with HIV infection. This study will also provide a source of baseline data for a further project that will include the last ten years at Tygerberg Hospita i.e. 2003 to 2012. OBJECTIVES: To establish the incidence and trends of prevalence of HNL; to describe the pathological spectrum of all HNICs diagnosed from 2003 to 2007. METHOD: A retrospective study was conducted using the case records of all newly diagnosed HNL specimens from 2003 to 2007. RESULTS: A statistically significant increase was noted in the number of patients presenting with HNL. An increase from 17% to 33% was also noted in the number of HIV-positive HNL patients during the same period. The average age of disease presentation in the HIV-positive group of patients was significantly lower Diffuse large cell lymphoma (DLBCL) was the largest category of HNL (32%), followed by Hodgkin lymphomas (HL) 27%, Folicular lymphoma (FL) 10% and Plasmablastic lymphoma (PBL) at 8%. PBL and Burkitt's lymphoma (BL) were seen only in HIV-positive patients. CONCLUSION: There was an increase in the number of HNLs diagnosed each year.

12 Article Improving access and quality of care in a TB control programme. 2012

Scott, Vera / Azevedo, Virginia / Caldwell, Judy. ·School of Public Health, University of the Western Cape, Bellville, Western Cape, South Africa. verascott@mweb.co.za ·S Afr Med J · Pubmed #23116738.

ABSTRACT: OBJECTIVES: To use a quality improvement approach to improve access to and quality of tuberculosis (TB) diagnosis and care in Cape Town. METHODS: Five HIV/AIDS/sexually transmitted infections/TB (HAST) evaluations were conducted from 2008 to 2010, with interviews with 99 facility managers and a folder review of over 850 client records per evaluation cycle. The data were used in a local quality improvement process: sub-district workshops identified key weaknesses and facility managers drew up action plans. Lessons learnt and successful strategies were shared at quarterly district-wide HIV/TB meetings. RESULTS: Geographical access was good, but there were delays in treatment commencement times. Access for high-risk clients improved significantly with intensified TB case finding made routine in both the HIV counselling and testing and antiretroviral treatment (ART) services (p<0.01 for both). Access for children in contact with an infectious case has improved but is still low (42% investigated and treated). Quality of care was mostly high at baseline (adherence to treatment protocols 95%). Measurement of body mass index improved from 20% to 62%. The assessment of contraception improved from 27% to 58%. Care for co-infected clients showed improved use of customised HIV stationery and increased assessment for ART eligibility. CONCLUSIONS: The HAST audit contributed to the improved TB cure rates by supplementing routine information and involving sub-district managers, facility managers and facility staff in a quality improvement process that identified local opportunities for programme strengthening.

13 Article Narratives of HIV disclosure and masculinity in a South African village. 2012

Mfecane, Sakhumzi. ·Department of Anthropology and Sociology, University of the Western Cape, Cape Town, South Africa. smfecane@uwc.ac.za ·Cult Health Sex · Pubmed #22236354.

ABSTRACT: This paper describes men's experiences of disclosing their HIV status, arguing that disclosure restored their social respect, which was previously undermined by an illness from AIDS. Results are from a 14-month ethnographic study conducted in rural South African health facility, among a group of 25 men attending an AIDS support group. The men included in this study tested while they were critically ill and some were negatively labelled as 'already dead' because of their poor state of health. The majority voluntarily disclosed their HIV status to the public after recovering from the physical symptoms of AIDS. This elicited positive reaction from the community, who treated them with admiration for disclosing their HIV status. The paper emphasises the fact that the good response received by participants from the community was predicated mainly on having healthy physical looks that men gained from using antiretroviral medication. This paper then further analyses the ways in which a 'healthy appearance' facilitates disclosure of HIV status and also disrupts the stigma attached to HIV in the studied community.