Increased Access to Antiretroviral Therapy Is Associated with Reduced Maternal Mortality in Johannesburg, South Africa: An Audit from 2003-2012

Black, Vivian; Black, Andrew; Rees, Helen; Guidozzi, F; Scorgie, Fiona; Chersich, Matthew

doi:10.1371/journal.pone.0168199

Cited by 6 publications

(6 citation statements)

References 12 publications

(14 reference statements)

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“…However, African research capacity has not yet reached the levels of that in high-income countries [36]. Although research areas of excellence already existed in the Wits Faculty of Health Sciences, and some of our researchers have contributed extensively to the international body of knowledge around HIV/AIDS, tuberculosis, malaria and drug delivery [see, for example, 37–43], there was a need to strengthen wider areas of research as well as increase the training and support for emergent researchers and postgraduate students in the Faculty. We believed, like Fonn [3], that it was important to initiate these strategies locally and ensure their sustainability.…”

Section: Discussionmentioning

confidence: 99%

Closing the barrier between disease and health outcomes in Africa through research and capacity development

Kramer

Libhaber

2018

Global Health Action

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Background: While the burden of disease in Africa is high, health research emanating from the continent is low. Building human capacity and research infrastructure to close the gap between research and disease is thus of great imporatance. Objective: In order to improve research outputs and postgraduate training in the Faculty of Health Sciences, University of the Witwatersrand, the Health Sciences Research Office put in place a series of strategic initiatives over time. Methods: A range of strategic activities, for both postgraduate students and academic staff, were developed in parallel and sequentially over a period of approximately nine years (2008–2016). The latter years were a time of consolidation of the programmes. Outcomes of these activities were ‘measured’ by increases in publications, decreases in time to graduation and enrichment of the research environment. Results: A doubling of research publications and an increase in citations occurred over the period under review. In addition, there was a decrease in the time postgraduate students took to graduate. Conclusions: A varied, but structured research management plan may be of value in African and other developing health sciences institutions to enable the increase in research outputs and capacity development, desperately needed to close the barrier between disease and health.

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Section: Discussionmentioning

confidence: 99%

Closing the barrier between disease and health outcomes in Africa through research and capacity development

Kramer

Libhaber

2018

Global Health Action

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“…In addition to the benefits of ART in lowering mortality and morbidity [ 6 – 8 ] and of starting treatment early [ 12 , 23 , 24 ], achieving low viral load among HIV-positive individuals has potential benefits in reducing HIV transmission [ 9 – 12 ]. One way of achieving lower viral load in a population is to increase ART coverage.…”

Section: Discussionmentioning

confidence: 99%

“…With only half the population of HIV-positive individuals on treatment, containing the spread of HIV remains a challenge with only small declines in incidence[ 5 ]. However, more evidence is becoming available on the benefits of undetectable viral load and early ART initiation on mortality and morbidity[ 6 – 8 ] and on lowering the risk of transmission[ 9 – 13 ], bringing hope on how further spreading of the disease can be contained through a “test and treat” approach.…”

Section: Introductionmentioning

confidence: 99%

Impact of "test and treat" recommendations on eligibility for antiretroviral treatment: Cross sectional population survey data from three high HIV prevalence countries

Chihana

Huerga²,

Cutsem

et al. 2018

PLoS ONE

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BackgroundLatest WHO guidelines recommend starting HIV-positive individuals on antiretroviral therapy treatment (ART) regardless of CD4 count. We assessed additional impact of adopting new WHO guidelines.MethodsWe used data of individuals aged 15–59 years from three HIV population surveys conducted in 2012 (Kenya) and 2013 (Malawi and South Africa). Individuals were interviewed at home followed by rapid HIV and CD4 testing if tested HIV-positive. HIV-positive individuals were classified as “eligible for ART” if (i) had ever been initiated on ART or (ii) were not yet on ART but met the criteria for starting ART based on country’s guidelines at the time of the survey (Kenya–CD4< = 350 cells/μl and WHO Stage 3 or 4 disease, Malawi as for Kenya plus lifelong ART for all pregnant and breastfeeding women, South Africa as for Kenya plus ART for pregnant and breastfeeding women until cessation of breastfeeding).FindingsOf 18,991 individuals who tested, 4,113 (21.7%) were HIV-positive. Using country’s ART eligibility guidelines at the time of the survey, the proportion of HIV-infected individuals eligible for ART was 60.0% (95% CI: 57.2–62.7) (Kenya), 73.4% (70.8–75.8) (South Africa) and 80.1% (77.3–82.6) (Malawi). Applying WHO 2013 guidelines (eligibility at CD4< = 500 and Option B+ for pregnant and breastfeeding women), the proportions eligible were 82.0% (79.8–84.1) (Kenya), 83.7% (81.5–85.6) (South Africa) and 87.6% (85.0–89.8) (Malawi). Adopting “test and treat” would mean a further 18.0% HIV-positive individuals (Kenya), 16.3% (South Africa) and 12.4% (Malawi) would become eligible. In all countries, about 20% of adolescents (aged 15–19 years), became eligible for ART moving from WHO 2013 to “test and treat” while no differences by sex were observed.ConclusionCountries that have already implemented 2013 WHO recommendations, the burden of implementing “test and treat” would be small. Youth friendly programmes to help adolescents access and adhere to treatment will be needed.

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“…It should be noted that studies performed on subnational levels report a declining MMR since the beginning of the 21 st century [ 6 , 7 ]. Some accredit this decline to higher coverage of Human Immunodeficiency Virus (HIV) testing and antiretroviral treatment [ 7 , 8 ], although it has been argued that the correlation between provincial MMR and HIV prevalence weak [ 9 ]. Limpopo is the northernmost province of SA.…”

Section: Introductionmentioning

confidence: 99%

Elucidating challenges and solutions in the maternal healthcare, identified by medical doctors in northern South Africa: a qualitative study

Olseén¹,

Mothiba²,

Skaal³

et al. 2020

Pan Afr Med J

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Introduction as South Africa's maternal mortality ratio increased between 1990 and 2015, the country failed to reach the United Nations millennium development goal 5a. The maternal mortality ratio of Limpopo province is higher than the national average and previous studies report shortages of manpower and medical equipment in Limpopo province. The overall study aim was to elucidate views and experiences of medical doctors regarding maternal healthcare by identifying the challenges they experience and solutions they suggest. Methods a qualitative interview-based study was performed with ten medical doctors as participants. Manifest content analysis was used to analyze the data. Results the main findings were categorized as lack of material and human resources, feelings of experienced isolation and solution-focused expressions. The challenges identified included logistical issues, staffing issues, demographic characteristics of the patient population, poor interinstitutional communication and lack of support from the administration. The solutions included revision of resource allocation and improvement of the interinstitutional cooperation. For example, participants suggested that exchange programs between hospitals could be arranged, that the emergency medical service personnel could triage patients and that private practitioners could be contracted to work at public institutions. Conclusion most identified challenges were related to a lack of resources. Based on their inside experience, the participants suggested several solutions. These firsthand accounts of the local medical doctors highlight the need for intervention and should be taken into account when it comes to improving the provincial healthcare and working toward achieving the healthcare-related sustainable development goals by 2030.

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Increased Access to Antiretroviral Therapy Is Associated with Reduced Maternal Mortality in Johannesburg, South Africa: An Audit from 2003-2012

Cited by 6 publications

References 12 publications

Closing the barrier between disease and health outcomes in Africa through research and capacity development

Closing the barrier between disease and health outcomes in Africa through research and capacity development

Impact of "test and treat" recommendations on eligibility for antiretroviral treatment: Cross sectional population survey data from three high HIV prevalence countries

Elucidating challenges and solutions in the maternal healthcare, identified by medical doctors in northern South Africa: a qualitative study

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