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Local mortality surveillance provides important data for planning, implementing and evaluating targeted health interventions at small-area level. Trends in mortality over the past decade indicate some gains in health and equity, but highlight the need for multisectoral interventions to focus on HIV and TB and homicide and the emerging epidemic of non-communicable diseases.

ObjectivesWe investigated the effects of an enhanced partner notification (PN) counselling intervention with the offer of provider-assisted referral among people diagnosed with STI in a Cape Town public clinic.MethodsParticipants were adults diagnosed with STI at a community clinic. After the standard STI consultation, participants were randomly allocated in a 1:1:1 ratio to (1) ‘HE’: 20 min health education; (2) ‘RR’: 45 min risk reduction skills counselling; or (3) ‘ePN’: 45 min enhanced partner notification communication skills counselling and the offer of provider-assisted referral. The primary outcome was the incidence of repeat STI diagnoses during the 12 months after recruitment, and the secondary outcome was participants’ reports 2 weeks after diagnosis of notifying recent partners. Incidence rate ratios (IRRs) were used to compare the incidence rates between arms using a Poisson regression model.ResultsThe sample included 1050 participants, 350 per group, diagnosed with STI between June 2014 and August 2017. We reviewed 1048 (99%) participant records, and identified 136 repeat STI diagnoses in the ePN arm, 138 in the RR arm and 141 in the HE arm. There was no difference in the annual incidence of STI diagnosis between the ePN and HE arms (IRR: 1.0; 95% CI 0.7 to 1.3), or between the RR and HE arms (IRR: 0.9; 95% CI 0.7 to 1.2). There was a greater chance of a partner being notified in the ePN condition compared with the HE condition, 64.3% compared with 53.8%, but no difference between the RR and HE arms.ConclusionsPN counselling and education with provider-assisted services has the potential to change the behaviour of people diagnosed with STIs, increasing the number of partners they notify by more than 10%. However, these changes in behaviour did not lead to a reduction of repeat STI diagnoses.Trial registration numberPACTR201606001682364.

A waiting time survey (WTS) conducted in several clinics in Cape Town, South Africa provided recommendations on how to shorten waiting times (WT). A follow-up study was conducted to assess whether WT had reduced. Using a stratified sample of 22 clinics, a before and after study design assessed changes in WT. The WT was measured and perceptions of clinic managers were elicited, about the previous survey’s recommendations. The overall median WT decreased by 21 minutes (95%CI: 11.77-30.23), a 28% decrease from the previous WTS. Although no specific factor was associated with decreases in WT, implementation of recommendations to reduce WT was 2.67 times (95%CI: 1.33-5.40) more likely amongst those who received written recommendations and 2.3 times (95%CI: 1.28-4.19) more likely amongst managers with 5 or more years’ experience. The decrease in WT found demonstrates the utility of a WTS in busy urban clinics in developing country contexts. Experienced facility managers who timeously receive customised reports of their clinic’s performance are more likely to implement changes that positively impact on reducing WT.

Objectives To assess the burden of STIs among HIV-positive South Africans in the period prior to ART initiation compared to the period once on ART. Methods We linked the clinic records of 1,465 patients currently on ART to the electronic database which records all visits to City clinics. We used a mixed effects Poisson model to assess the relative rates of occurrence of treatment seeking for an STI in the periods prior to initiation of ART and while on ART. Results We accumulated 4,214 person-years of follow-up, divided nearly equally between the pre-ART and on ART periods. The rate of treatment seeking for new STIs was 5.50 (95% CI 5.43–5.78) per 100 person-years, and individuals had on average a seven-fold higher rate of seeking treatment for STIs in the period prior to initiating ART (9.57 per 100 person-years) compared to the period once on ART (5.5 per 100 person-years) (adjusted rate ratio [RR] 7.01, 95% CI 4.64–10.59). Being male (RR 1.73, 95% CI 1.18–2.55) or younger (

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