High prevalence of multimorbidity and non-communicable disease risk factors in South African adolescents and youth living with HIV: Implications for integrated prevention.

BACKGROUND: Adolescents and youth living with HIV (AYLHIV) face an elevated non-communicable disease (NCD) risk resulting from HIV, psychosocial challenges, and the complications of antiretroviral therapy. OBJECTIVES: To investigate the prevalence of common NCDs and their risk factors among AYLHIV in urban Cape Town, South Africa, in order to inform an integrated approach to NCD screening and prevention in AYLHIV. METHODS: We conducted a cross-sectional study in six primary care facilities in Cape Town between March 2019 and January 2020. We collected sociodemographic information, and assessed dietary intake, physical activity and nutritional knowledge. We also screened for pre-existing and previously unidentified NCDs and modifiable risk factors in 92 adolescents and youth receiving treatment for HIV in primary care settings using self-report and objective measures. Differences between sexes and age groups were compared using parametric and non-parametric statistical tests. RESULTS: Three out of four participants were female, and the median (interquartile range) age was 20.5 (18.9 - 22.9) years. More than a quarter were not in education, employment or training, and 44% were multidimensionally poor. Five percent of participants had measured hypertension, and 37% had central obesity. AYLHIV self-reported high levels of household food insecurity (70%), low daily fruit and vegetable consumption (28% and 52%, respectively), high refined sugar and sugar-sweetened beverage intake (31% and 29% daily intake, respectively), regularly skipping breakfast (42%), low nutritional knowledge (37% average score) and insufficient weekly physical activity levels (31%). A third (30%) were current smokers, and 24% engaged in binge drinking. CONCLUSIONS: Our findings of a high prevalence of NCDs and risk factors in AYLHIV highlight the importance of NCD risk screening as part of HIV care for AYLHIV. Such integrated approaches are needed to achieve the dual purpose of improving outcomes through early diagnosis of pre-existing NCDs as well as the prevention of NCD multimorbidity in AYLHIV. This study further demonstrates the need for early intervention on the social, environmental and economic determinants of NCDs targeting adolescents and youth.

JOB SATISFACTION AND PSYCHOLOGICAL HEALTH AMONG HEALTH WORKERS IN LAGOS STATE TEACHING HOSPITAL, NIGERIA.

Background: Dissatisfactions found in various jobs have been identified as workplace stressors that can directly influence an employee's psychological and physical health. This study assessed job satisfaction and its relationship with the psychological health of health workers at the Lagos State University Teaching Hospital (LASUTH). Methods: The study was a descriptive cross-sectional survey conducted among 440 health workers in LASUTH. Participants were selected using the stratified sampling technique with the probability proportionate to size method. Data was collected using a self-administered questionnaire consisting of three sections: sociodemographic characteristics and work history, the Spector Job Satisfaction Survey (JSS) and the General Health Questionnaire short version 12 (GHQ-12). Apart from the multidimensional JSS, the overall job satisfaction was also assessed using the single-item measure. Data was analysed with SPSS version 25.0. The level of statistical significance was d" 0.5. Results: The mean age of respondents was 43.1 ± 9.2 years. Only 95 (21.6%) respondents expressed satisfaction on the single-item measure. Based on the JSS, the mean job satisfaction score was 126 ± 11.1 and mean GHQ score was 2.88 ± 2.43. There was a consistent weak negative correlation between job satisfaction scores and GHQ scores (p < 0.001). Furthermore, respondents who were satisfied with their job were less likely to have psychological morbidity (p < 0.001). Conclusion: Job satisfaction among respondents was low. This was associated with a high level of psychological morbidity. There is need for further investigations on the contemporary causes of job dissatisfaction.

Culture Matters in Communicating the Global Response to COVID-19.

Current communication messages in the COVID-19 pandemic tend to focus more on individual risks than community risks resulting from existing inequities. Culture is central to an effective community-engaged public health communication to reduce collective risks. In this commentary, we discuss the importance of culture in unpacking messages that may be the same globally (physical/social distancing) yet different across cultures and communities (individualist versus collectivist). Structural inequity continues to fuel the disproportionate impact of COVID-19 on black and brown communities nationally and globally. PEN-3 offers a cultural framework for a community-engaged global communication response to COVID-19.

The association between a detectable HIV viral load and non-communicable diseases comorbidity in HIV positive adults on antiretroviral therapy in Western Cape, South Africa.

BACKGROUND: Past studies have found a relationship between detectable HIV viral load and non-communicable diseases (NCDs) in HIV-infected individuals on antiretroviral therapy in high-income settings, however there is little research in South Africa. Our objective was to investigate the association between detectable HIV viral load and prevalent NCDs in a primary health centre in peri-urban South Africa. METHODS: HIV-infected adults (aged ≥25) who had been on antiretroviral therapy for ≥ six months and attended the HIV clinic within a primary health centre in Khayelitsha, Cape Town, were recruited. We recorded participants' demographics, HIV characteristics, the presence of NCDs via self-report, from clinic folders and from measurement of their blood pressure on the day of interview. We used logistic regression to estimate the association between a detectable HIV viral load and NCD comorbidity. RESULTS: We recruited 330 adults. We found no association between a detectable HIV viral load and NCD comorbidity. Within our multivariable model, female gender (OR3·26; p = 0·02) age > 35 (OR 0·40; p = 0·02) low CD4 count (compared to CD4 < 300 (reference category): CD4:300-449 OR 0·28; CD4:450-599 OR 0·12, CD4:≥600 OR 0·12; p = < 0·001), and ever smoking (OR 3·95; p = < 0·001) were associated with a detectable HIV viral load. We found a lower prevalence of non-communicable disease in clinic folders than was self-reported. Furthermore the prevalence of hypertension measured on the day of interview was greater than that reported on self-report or in the clinic folders. CONCLUSIONS: The lack of association between detectable viral load and NCDs in this setting is consistent with previous investigation in South Africa but differs from studies in high-income countries. Lower NCD prevalence in clinic records than self-report and a higher level of hypertension on the day than self-reported or recorded in clinic folders suggest under-diagnosis of NCDs in this population. This potential under-detection of NCDs may differ from a high-income setting and have contributed to our finding of a null association. Our findings also highlight the importance of the integration of HIV and primary care systems to facilitate routine monitoring for non-communicable diseases in HIV-infected patients.

The Pan-University Network for Global Health: framework for collaboration and review of global health needs.

In the current United Nations efforts to plan for post 2015-Millennium Development Goals, global partnership to address non-communicable diseases (NCDs) has become a critical goal to effectively respond to the complex global challenges of which inequity in health remains a persistent challenge. Building capacity in terms of well-equipped local researchers and service providers is a key to bridging the inequity in global health. Launched by Penn State University in 2014, the Pan University Network for Global Health responds to this need by bridging researchers at more than 10 universities across the globe. In this paper we outline our framework for international and interdisciplinary collaboration, as well the rationale for our research areas, including a review of these two themes. After its initial meeting, the network has established two central thematic priorities: 1) urbanization and health and 2) the intersection of infectious diseases and NCDs. The urban population in the global south will nearly double in 25 years (approx. 2 billion today to over 3.5 billion by 2040). Urban population growth will have a direct impact on global health, and this growth will be burdened with uneven development and the persistence of urban spatial inequality, including health disparities. The NCD burden, which includes conditions such as hypertension, stroke, and diabetes, is outstripping infectious disease in countries in the global south that are considered to be disproportionately burdened by infectious diseases. Addressing these two priorities demands an interdisciplinary and multi-institutional model to stimulate innovation and synergy that will influence the overall framing of research questions as well as the integration and coordination of research.

Metal ion levels following resurfacing arthroplasty of the hip: serial results over a ten-year period.

We report serum metal ion level data in patients with unilateral and bilateral hip resurfacing over a ten-year period. In these patients there is an increase in both cobalt and chromium levels above the accepted reference ranges during the first 18 months after operation. Metal ion levels remain elevated, but decline slowly for up to five years. However, the levels then appear to start rising again in some patients up to the ten-year mark. There was no significant difference in cobalt or chromium levels between men and women. These findings appear to differ from much of the current literature. The clinical significance of a raised metal ion level remains under investigation.

Changing prevalence of tuberculosis infection with increasing age in high-burden townships in South Africa.

SETTING: Crowded townships of Cape Town, South Africa, where human immunodeficiency virus (HIV) prevalence and tuberculosis (TB) notification rates are among the highest in the world. OBJECTIVES: To determine age-specific prevalence rates of latent tuberculosis infection (LTBI) among HIV-negative individuals, and the annual risk and force of infection during childhood and adolescence. DESIGN: A cross-sectional survey using a standardised tuberculin skin test (TST) in HIV-negative individuals aged 5-40 years. A TST diameter of > or =10 mm was defined as indicative of LTBI. RESULTS: Among 1061 individuals, only 4.7% had low-grade TST responses of 1-9 mm. However, the proportions of individuals with TST > or =10 mm increased from 28.0% in the 5-10 year age stratum to 88.0% in the 31-35 year age stratum. The mean annual risk of infection was 3.9% up to 5 years of age. The estimated force of infection (the rate of acquisition of LTBI among the residual pool of non-infected individuals) increased throughout childhood to a maximum of 7.9% per year at age 15 years. CONCLUSIONS: Extremely high rates of infection in childhood and adolescence result in very high LTBI prevalence rates in young adults who are most at risk of acquiring HIV infection. This may be an important factor fuelling the high rates of HIV-associated TB in southern Africa.

Enhanced diagnosis of HIV-1-associated tuberculosis by relating T-SPOT.TB and CD4 counts.

The sensitivity of the tuberculin skin test is impaired in HIV-1-infected persons. Enzyme-linked immunospot-based detection of immune sensitisation may be less affected. Furthermore, the quantitative response can be related to the CD4 count, potentially improving specificity for active disease. The T-SPOT.TB assay was performed on HIV-1-infected participants, 85 with active tuberculosis (TB) and 81 healthy patients (non-TB). The ratio of the sum of the 6-kDa early secretory antigenic target and culture filtrate protein 10 response to the CD4 count (spot-forming cell (SFC)/CD4) was calculated. Using the manufacturer's guidelines, active TB was diagnosed with 76% sensitivity and 53% specificity. Using an SFC/CD4 ratio of 0.12, sensitivity (80%) and specificity (62%) improved. The quantitative T-cell response increased with increasing smear-positivity in the active TB group (p = 0.0008). In the non-TB group, the proportion of persons scored positive by T-SPOT.TB assay was lower in the group with a CD4 count of <200 cells·mm(-3) (p = 0.029). The ratio of the summed T-cell response to CD4 count improved the diagnostic accuracy of the T-SPOT.TB assay in HIV-1-infected persons, and a ratio of SFC/CD4 of >0.12 should prompt investigation for active disease. A strong association between the degree of sputum positivity and T-SPOT.TB score was found. The sensitivity of the T-SPOT.TB assay in active disease may be less impaired by advanced immunosuppression.