Long-Term Outcome of an HIV-Treatment Programme in Rural Africa: Viral Suppression despite Early Mortality

Objective. To define the long-term (2–4 years) clinical and virological outcome of an antiretroviral treatment (ART) programme in rural South Africa. Methods. We performed a retrospective observational cohort study, including 735 patients who initiated ART. Biannual monitoring, including HIV-RNA testing, was performed. Primary endpoint was patient retention; virological suppression (HIV-RNA < 50 copies/mL) and failure (HIV-RNA > 1000 copies/mL) were secondary endpoints. Moreover, possible predictors of treatment failure were analyzed. Results. 63% of patients (466/735) have a fully suppressed HIV-RNA, a median of three years after treatment initiation. Early mortality was high: 14% died within 3 months after treatment start. 16% of patients experienced virological failure, but only 4% was switched to second-line ART. Male gender and a low performance score were associated with treatment failure; immunological failure was a poor predictor of virological failure. Conclusions. An “all or nothing” phenomenon was observed in this rural South African ART programme: high early attrition, but good virological control in those remaining in care. Continued efforts are needed to enrol patients earlier. Furthermore, the observed viro-immunological dissociation emphasises the need to make HIV-RNA testing more widely available

Unmasking a silent killer: Prevalence of diagnosed and undiagnosed Diabetes Mellitus among people living with HIV in rural South Africa

OBJECTIVES: To document the prevalence of impaired glucose tolerance (IGT) and undiagnosed diabetes mellitus (DM) and to identify factors associated with undiagnosed DM in people living with HIV (PLWH). METHODS: Cross-sectional study performed at Ndlovu Medical Center, Limpopo, South Africa including PLWH aged ≥18 years. Between August and November 2017, 356 HIV-positive participants were included. Information was collected on socio-demographics, DM symptoms and risk factors for DM. IGT and DM were diagnosed using random plasma glucose and/or HbA1c. Factors associated with undiagnosed DM were assessed by comparing participants with newly diagnosed DM to participants without DM. RESULTS: IGT was diagnosed in 172 (48.3%) participants. Twenty-nine (8.1%) participants met the definition of DM, of whom 17 (58.6%) were newly diagnosed. Compared to participants without DM, participants with DM were on average 5 years older, were more likely to have a positive family history for DM, were less physically active and had higher systolic blood pressure, body mass index and waist circumference. Factors associated with undiagnosed DM included age ≥45 years (odds ratio [OR] = 3.59) and physical inactivity (OR = 3.17). CONCLUSIONS: The prevalence of IGT and DM among PLWH is high and more than half of DM cases were undiagnosed. Regular screening for DM in PLWH is recommended, especially in an ageing population with additional cardiovascular disease risk factors

Fraksies en geïsoleerde verbindings uit Tecoma stans (Bignoniaceae), ’n indringerplant het belowende aktiwiteit teen fungus fitopatogene

Fungi wat plante aanval lei tot groot verliese in plantproduktiwiteit en ook tot verliese in opbrengs nadat die produkte geoes is. Die beheer van hierdie fungi deur chemiese fungisiede lewer komplikasies vanweë menslike en omgewingstoksisiteit. Die koste en die ontwikkeling van weerstand deur plant patogeniese fungi teen fungisiede lewer ook probleme. Sekondêre plant metaboliete het ‘n goeie potensiaal as antifungusverbindings. Die doel van die studie was om die aktiwiteit van Tecoma stans ekstrakte en fraksies te bepaal en om die aktiewe verbinding te isoleer deur die bioaktiwiteit van fraksies gedurende die fraksionering te bepaal. Die dichlorometaanfraksie het die hoogste aktiwiteit gehad en die geïsoleerde verbinding se struktuur is bepaal as oleanoliese suur. Die antifungus aktiwiteit en is bepaal teen tien belangrike plant fungus patogene (Aspergillus niger, Aspergillus parasiticus, Collectotrichum glaeospariodes, Fusarium oxysporium, Penicillum expansum, Penicillum janthinellum, Pythium ultimum, Phytophthora nicotiana, Trichoderma harzianum en Rhizoctonia solani). Die gemiddelde minimum iinhiberende konsentrasie was 130 μg/mL. Die DCM-ekstrak en oleanoliese suur was minder toksies as die positiewe kontrole berberien teen Vero-selle met LC50 waardes van 0.413 mg/mL, 0.129 mg/mL en 15.48 µg/mL respektiewelik. Die selektiwiteitindeks van 20 met verskeie fungi dui op moontlike relatiewe veiligheid om onder gekontroleerde toestande selfs vir eetbare produkte te gebruik. Die groot massa plantmateriaal wat beskikbaar is van hierdie indringeplant mag tot ‘n kommersieel bruikbare produk lei in die bekamping van fitopatogeniese fungi

Endothelial biomarkers and Von Willebrand factor in human immunodeficiency virus-naïve individuals in a semi-rural community of Mankweng area, Capricorn District, Limpopo Province, South Africa

The human immunodeficiency virus (HIV) has infected over 70 million people globally. The Sub-Saharan African countries have over 23.5 million people living with HIV, with South Africa having over 17% of the total number of HIV-infected people globally. The infection leads to metabolic, thrombotic and cardiovascular disease complications. There is a scarcity of studies on biomarkers of HIV infection in South Africa, hence the study and the focus on rural areas. The cross-sectional study investigated the effects of HIV infection on the L-selectin, P-Selectin, soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1) as endothelial biomarkers and, Von Willebrand factor (VWF). The study included 87 participants (males: n = 33; females: n=54), aged 18 – 81 years. It consisted of 36 HIV-positive participants not on treatment (HIV-naïve) and 51 HIV-negative participants. The L-Selectin, P-Selectin, sICAM-1, sVCAM-1 and VWF levels were measured on fasting blood samples. Chi-square, Bonferroni post hoc and Kruskal-Wallis statistical tests were performed. The HIV-naïve group was found to have mean values for L-selectin, P-selectin, sICAM-1 and VWF significantly higher than those of the HIV-negative group (p-values: 0.010, 0.001, 0.017 and 0.013, respectively). Human immunodeficiency virus infection was thus found to be inflammatory, with blood levels of some endothelial biomarkers and VWF raised. Endothelial damage and dysfunction were the anticipated complications based on the findings

Experiences of students who gained entry to a nursing college through recognition of prior learning : a phenomenological study

BACKGROUND : Recognition of prior learning broadens employees' access to higher education and career progress. In South Africa, the process provides previously disadvantaged nurses a fair and equitable opportunity to further their education. It is necessary to understand the support needs of these nurses. OBJECTIVE : To describe the lived experiences of students who gained entry through recognition of prior learning to a three- or four-year nursing training programme at a nursing college in South Africa. DESIGN : A qualitative descriptive phenomenological approach was used to explore and describe the meanings students attached to their educational experiences. SETTING : A public nursing college in South Africa. PARTICIPANTS : Ten nursing students who gained entry through recognition of prior learning were purposefully selected. METHODS : Data were collected over a period of three months, using in-depth individual interviews, and analysed using Giorgi's descriptive phenomenological method. RESULTS : Nursing students who furthered their studies through recognition of prior learning experienced various academic, clinical practice and personal challenges that instilled in them a fear of failure and self-doubt. They used social support from various sources as a way of coping. Previously disadvantaged nursing students require institutional interventions and support to improve their chances of success. CONCLUSIONS : Nurses given the opportunity to advance their careers through recognition of prior learning should have access to person-centred support, academic orientation and resources to attain language and technological competency.https://www.elsevier.com/locate/nedt2023-07-13hj2023Nursing Scienc