Rapid and Successful Implementation of a COVID-19 Convalescent Plasma Programme—The South African Experience

Background: COVID-19 convalescent plasma (CCP) has been considered internationally as a treatment option for COVID-19. CCP refers to plasma collected from donors who have recovered from and made antibodies to SARS-CoV-2. To date, convalescent plasma has not been collected in South Africa. As other investigational therapies and vaccination were not widely accessible, there was an urgent need to implement a CCP manufacture programme to service South Africans. Methods: The South African National Blood Service and the Western Cape Blood Service implemented a CCP programme that included CCP collection, processing, testing and storage. CCP units were tested for SARS-CoV-2 Spike ELISA and neutralising antibodies and routine blood transfusion parameters. CCP units from previously pregnant females were tested for anti-HLA and anti-HNA antibodies. Results: A total of 987 CCP units were collected from 243 donors, with a median of three donations per donor. Half of the CCP units had neutralising antibody titres of >1:160. One CCP unit was positive on the TPHA serology. All CCP units tested for anti-HLA antibodies were positive. Conclusion: Within three months of the first COVID-19 diagnosis in South Africa, a fully operational CCP programme was set up across South Africa. The infrastructure and skills implemented will likely benefit South Africans in this and future pandemics.     

The psychosocial determinants of the intention to reduce the number of sexual partners among recent traditionally initiated and circumcized men in the Eastern Cape Province, South Africa

This study focuses on the factors associated with the intention to reduce the number of sexual partners. An individual face-to-face interview was used to collect data amongst 2337 traditionally initiated and circumcized men in the rural areas of Eastern Cape Province, South Africa. About 55.5% reported having a main sexual partner and of those 41.4% indicated having other sexual partners. The strongest association with intention was found for self-efficacy towards having one sexual partner, which accounted for almost 49% of the variance. These findings provide specific information for the development of a focused cultural sensitive STI/HIV prevention programme in sexually active young men, which can be integrated into the initiation and health education practices.     

The Association Between Ethnic Identity and Condom Use Among Young Men in the Eastern Cape Province,South Africa

This article reports on the association between ethnic identity and condom use among Black African men in the rural areas of the Eastern Cape Province, South Africa. Individual face-to-face structured interviews were conducted by trained community research assistants among 1,656 men who had undergone traditional initiation and male circumcision. Logistic regression analyses were used to explore the association between two components of ethnic identity (cultural affiliation and cultural alienation) and condom use. Overall, 49.2 % of the participants reported using condoms consistently and, of these users, 66.4 % used them correctly. Logistic regression adjusting for age, employment status, education level, and nation of origin showed that participants who expressed high as opposed to low cultural affiliation were significantly more likely to use condoms consistently and correctly when having sex, especially if they reported to have more than one sexual partner. Cultural alienation was negatively related with consistent condom use, whereas its association with correct use was unclear. The findings of this study suggest that positively emphasizing the ethnic identity of African black men may promote condom use.     

Dolutegravir in real life: Self-reported mental and physical health outcomes after transitioning from efavirenz- to dolutegravir-based antiretroviral therapy in a prospective cohort study in Lesotho

Introduction

HIV programmes across many countries in Africa have recently transitioned people living with HIV from efavirenz (EFV)- to dolutegravir (DTG)-containing antiretroviral therapy (ART). As both drugs are associated with neuropsychiatric adverse effects, this study assessed the mental health and HIV/ART-associated symptoms of people living with HIV before and after transition to DTG.

Methods

The prospective DO-REAL cohort enrolled people starting DTG-based ART in Lesotho from February to December 2020. For this analysis within DO-REAL, we included adults changing from tenofovir disoproxil fumarate (TDF)/lamivudine (3TC)/EFV to TDF/3TC/DTG within first-line therapy. At transition and 16 weeks thereafter, participants completed the Patient Health Questionnaire-9 (PHQ-9; depression screening), the 12-item Short-Form Health Survey (SF-12; mental and physical health), and a modified HIV Symptom Index (mHSI; HIV/ART-related symptoms). We also assessed weight change. We used McNemar tests with Bonferroni corrections to assess binary outcomes. ClinicalTrials.gov : NCT04238767.

Results

Among 1228 participants, 1131 completed follow-up. Of these, 60.0% were female, the median age was 46 years (interquartile range [IQR] 38–55), and the median time taking ART was 5.7 years (IQR 3.5–8.9). No change was observed for weight or overall PHQ-9 or SF-12 outcomes. However, three mHSI items decreased at follow-up: ‘feeling sad/down/depressed’ (bothered 6.0% vs. 3.3% of participants at least ‘a little’ before vs. after transition; adjusted p = 0.048); ‘feeling nervous/anxious’ (7.4% vs. 3.4%; adjusted p = 0.0009); and ‘nightmares, strange/vivid dreams’ (6.3% vs. 3.5%; adjusted p = 0.027). Individual PHQ-9 or SF-12 items also improved. Being symptom free across all measures increased from 5.1% to 11.4% (p < 0.0001).

Conclusions

We observed no negative impacts and potential moderate improvements with DTG, providing further support for the rollout of DTG.     

The association between ethnic identity and sexual coercion among young men in the Eastern Cape Province, South Africa

Sexual coercion by males poses important ethical, legal and public health challenges. Individual face-to-face structured interviews were conducted among 1656 men who had undergone male initiation and circumcision in rural areas of the Eastern Cape Province. Overall, 8.4 per cent of the participants reported ever having forced someone to have sex. Logistic regression adjusting for age, working status, education level and nation of origin showed that participants that expressed high cultural affiliation were significantly less likely to sexually coerce someone. The findings suggest that emphasizing cultural commitment may reduce sexual coercion, though findings need to be replicated.     

Rapid increases in overweight and obesity among South African adolescents: comparison of data from the South African National Youth Risk Behaviour Survey in 2002 and 2008

Objectives. To aid future policy and intervention initiatives, we studied the prevalence and correlates of overweight and obesity among participants in the South African National Youth Risk Behaviour Survey in 2002 and 2008.Methods. The survey collected data from nationally representative cross-sectional samples of students in grades 8 through 11 (n = 9491 in 2002 and 9442 in 2008) by questionnaire and measurement of height and weight. We stratified data on overweight and obesity rates by age, socioeconomic status, and race/ethnicity.Results. Among male adolescents, overweight rates increased from 6.3% in 2002 to 11.0% in 2008 (P < .01); among female adolescents, overweight rates increased from 24.3% in 2002 to 29.0% in 2008 (P < .01). Obesity rates more than doubled among male adolescents from 1.6% in 2002 to 3.3% in 2008 (P < .01) and rose from 5.0% to 7.5% among female adolescents (P < .01). We observed a dose–response relationship in overweight and obesity rates across socioeconomic categories. Rates of overweight and obesity were significantly higher among urban youths than among rural youths (P < .01).Conclusions. South Africa is experiencing a chronic disease risk transition. Further research is needed to better understand and effectively address this rapid change.Improving socioeconomic conditions, participation in global markets, exposure to world cultures, and many other aspects of globalization can convey tremendous benefits to developing societies. However, this progress can also have unintended deleterious health consequences. The World Health Organization has called this process risk transition¹; others have called it epidemiological transition and nutrition transition.^2–4 Risk transition occurs as disease prevalence shifts from being primarily infectious in nature, such as diarrhea and pneumonia, to primarily noncommunicable conditions, such as cardiovascular disease and cancers. Factors that contribute to this shift include improved medical care, aging of the population, public health interventions such as education and vaccinations, improved sanitation, better economic conditions, and related lifestyle changes. Nutrition transition, which can be thought of as a subcategory of risk transition, is characterized by a decrease in undernutrition and the emergence of overnutrition.⁴ Mid-transition, both types of conditions can be prevalent in the same population.⁵Signs of risk transition have been observed in many developing countries, and data suggest that its pace may be faster than previously thought.^2,6–8 For example, in Ghana, the prevalence of overweight (body mass index [BMI; defined as weight in kilograms divided by the square of height in meters] ≥ 25 kg/m²) in adolescent girls aged 15 to 19 years increased from 8% to 10.3% between 2003 and 2008.⁹ Obesity rates in a pooled sample of adolescent girls and women aged 15 years and older living in urban areas of 6 African countries (Burkina Faso, Ghana, Malawi, Niger, Senegal, and Tanzania) rose from 17.9% to 25.4% between 1992 and 2003.¹⁰ A study of Algerian children aged 6 to 10 years found an increase in overweight (including obesity) prevalence from 6.8% in 2001 to 9.5% in 2006.¹¹ A study among youths aged 7 to 18 years in 16 major cities across China found increases of 1.1 BMI units among boys and 0.8 units among girls from 1995 to 2005.¹² In a district in Kerala, India, overweight among youths aged 5 to 16 years increased significantly, from 4.9% in 2003 to 6.6% in 2005.¹³Previous studies among adults and children suggest that the speed at which this transition appears to be occurring in South Africa is particularly striking.^14–19 To further document risk transition and aid policymakers'' response to it, we studied the prevalence and correlates of overweight and obesity among South African high school students in 2002 and 2008.     

Kganya Motsha Adolescent Centre: a model for adolescent friendly HIV management and reproductive health for adolescents in Soweto,South Africa

This paper reports on Kganya Motsha Adolescent Centre, an adolescent program specifically established to provide voluntary counseling and testing as well as management of HIV-positive young people in Soweto, South Africa. A retrospective cross-sectional analysis, using clinic records of young people accessing services from 2008 to 2012, was conducted. Of the 11,522 who tested, 7689 (67%) were females. The total number of HIV infections was 410, with an HIV prevalence of 3.6% (95% CI 3.2–3.9%). More females (332, 4% vs. 72, 2%; p < 0.0001) were HIV-infected than males. Of those testing HIV positive, 109 (26.5%) had a median CD4 cell count of 491 (IQR 345–686) cells/mm³. Only 12/410 individuals (2.9%) were eligible for antiretroviral treatment and 10 (2.4%) of those successfully received treatment. The program observed that young people testing HIV positive would not return for follow up blood specimens or confirmatory results. Future programs should consider innovative ways of retaining adolescents in care to reduce potential HIV transmissions that could lead to deteriorating health.     

Laboratory Misidentifications Resulting from Taxonomic Changes to Bacillus cereus Group Species, 2018–2022

Whole-genome sequencing (WGS) is being applied increasingly to Bacillus cereus group species; however, misinterpretation of WGS results may have severe consequences. We report 3 cases, 1 of which was an outbreak, in which misinterpretation of B. cereus group WGS results hindered communication within public health and industrial laboratories.