The impact of same-day antiretroviral therapy initiation on retention in care and clinical outcomes at four eThekwini clinics, KwaZulu-Natal, South Africa.

BACKGROUND: Same-day initiation (SDI) of antiretroviral therapy (ART) increases ART uptake, however retention in care after ART initiation remains a challenge. Public health behaviours, such as retention in HIV care and adherence to antiretroviral therapy (ART) pose major challenges to reducing new Human Immunodeficiency Virus (HIV) transmission and improving health outcomes among HIV patients. METHODS: We evaluated 6-month retention in care, and clinical outcomes of an ART cohort comprising of SDI and delayed ART initiators. We conducted a 6 months' observational prospective cohort study of 403 patients who had been initiated on ART. A structured questionnaire was used to abstract data from patient record review which comprised the medical charts, laboratory databases, and Three Interlinked Electronic Registers.Net (TIER.Net). Treatment adherence was ascertained by patient visit constancy for the clinic scheduled visit dates. Retention in care was determined by status at 6 months after ART initiation. RESULTS: Among the 403 participants enrolled in the study and followed up, 286 (70.97%) and 267 (66.25%) complied with scheduled clinics visits at 3 months and 6 months, respectively. One hundred and thirteen (28.04%) had been loss to follow-up. 17/403 (4.22%) had died and had been out of care after 6 months. 6 (1.49%) had been transferred to other health facilities and 113 (28.04%) had been loss to follow-up. Among those that had been lost to follow-up, 30 (33.63%) deferred SDI while 75 (66.37%) initiated ART under SDI. One hundred and eighty-nine (70.79%) participants who had remained in care were SDI patients while 78 (29.21%) were SDI deferred patients. In the bivariate analysis; gender (OR: 1.672; 95% CI: 1.002-2.791), number of sexual partners (OR: 2.092; 95% CI: 1.07-4.061), age (OR: 0.941; 95% CI: 0.734-2.791), ART start date (OR: 0.078; 95% CI: 0.042-0.141), partner HIV status (OR: 0.621; 95% CI: 0.387-0.995) and the number of hospitalizations after HIV diagnosis (OR: 0.173; 95% CI: 0.092-0.326). were significantly associated with viral load detection. Furthermore, SDI patients who defaulted treatment were 2.4 (95% CI: 1.165-4.928) times more likely to have increased viral load than those who had been returned in care. CONCLUSION: Viral suppression under SDI proved higher but with poor retention in care. However, the results also emphasise a vital need, to not only streamline processes to increase immediate ART uptake further, but also to ensure retention in care.

Community engagement processes in low- and middle-income countries health research settings: a systematic review of the literature.

BACKGROUND: Community Engagement is an important ethical imperative in research. Although substantial research emphasizes its real value and strategic importance, much of the available literature focuses primarily on the success of community participation, with little emphasis given to specific community engagement processes, mechanisms and strategies in relation to intended outcomes in research environments. The systematic literature review's objective was to explore the nature of community engagement processes, strategies and approaches in health research settings in low- and middle-income countries. METHODS: The systematic literature review design was informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched for peer-reviewed, English-language literature published between January 2011 and December 2021 through three databases on the internet (PubMed, Web of Science and Google Scholar). The terms "community engagement," "community involvement," "participation," "research settings," and "low- and middle-income countries" were merged in the search. RESULTS: The majority of publications [8/10] were led by authors from low- and middle-income countries, with many of them, [9/10] failing to continuously include important aspects of study quality. Even though consultation and information sessions were less participatory, articles were most likely to describe community engagement in these types of events. The articles covered a wide range of health issues, but the majority were concerned with infectious diseases such as malaria, human immunodeficiency virus, and tuberculosis, followed by studies on the environment and broader health factors. Articles were largely under-theorized. CONCLUSIONS: Despite the lack of theoretical underpinnings for various community engagement processes, strategies and approaches, community engagement in research settings was variable. Future studies should go deeper into community engagement theory, acknowledge the power dynamics underpin community engagement, and be more practical about the extent to which communities may participate.

Patients' views on health promotion and disease prevention services provided by healthcare workers in a South African tertiary hospital.

BACKGROUND: Patients' views and experiences in healthcare institutions provide a means of assessing the quality of services patients receive from healthcare workers (HCWs). However, the views of patients on the health promotion (HP) and disease prevention (DP) services offered by HCWs and the delivery mode have not been adequately studied. AIM: This study assessed the views of patients on HP and DP services provided by various categories of HCWs. SETTING: The study was conducted at a tertiary hospital in the Nelson Mandela Bay Municipality, South Africa. METHOD: An exploratory cross-sectional study was conducted among 500 patients. The questionnaire elicited responses from patients regarding the HP and DP services received from the different cadres of HCWs at three different admission phases: pre-admission phase (PAP), admission phase (ADP), and post-admission phase (POP). Descriptive, bivariate, and multivariate analysis was conducted. RESULTS: In the PAP, most patients (83.33%, n = 5; 87.85%, n = 217; and 76.14%, n = 150) seen by the rehabilitation health workers, medical doctors, and nurses respectively were empowered to manage their health. Patients attended to by nurses were 0.45 (95% CI 0.27-0.74) times less likely than those attended to by medical doctors to receive information that that will help them address the physical and environmental needs. In the ADP, patients attended to by nurses were less likely, compared to those attended to by medical doctors to be empowered to have good control over their health. In the POP, patients attended to by nurses are more likely to have their health behaviours change for better compared to those not seen by any HCW. CONCLUSION: Patients attending tertiary hospital received greater HP and DP services during the PAP and ADP of patient care. Greatest influence for behavioural change of patients on HP and DP were achieved from the medical doctors, nurses and rehabilitation service staff. Improving structural factors may prove beneficial in enhancing patients' experience from all HCW groups and phases of patient care.

Adherence to Oral Anticancer Medications Among Women With Breast Cancer in Africa: A Scoping Review.

PURPOSE: Oral anticancer medications (OAMs) improve treatment outcomes and survival in women with breast cancer (BC). However, adherence to OAM therapy remains suboptimal. This scoping review provides evidence of adherence to OAMs among African women with BC. METHODS: We searched four databases and gray literature, using guidance from the Joanna Briggs Institute. Thirteen studies on adherence rates, determinants, and interventions were included. NVivo 12 software was used to perform thematic analysis of the included studies. The determinants (barriers and facilitators) associated with adherence were analyzed according to the five dimensions of the WHO multidimensional adherence model. RESULTS: Most studies (n = 11, 85%) focused on endocrine medication. Depending on the definition, measurements, and assessment period, the nonadherence rates ranged from 4.3% to 65.4% for endocrine medications, 80.9% for cytotoxic chemotherapies, and 32.7% for combined medications. The significant barriers associated with adherence include Islamic religion, concurrent comorbidities, mastectomy, anastrozole treatment, side effects, unawareness of treatment insurance coverage, and seeking treatment from traditional healers. Thorough therapeutic communication regarding treatment, neoadjuvant chemotherapy, and adequate social support significantly facilitate adherence. A randomized controlled trial of breast nursing interventions reported improved patient adherence. CONCLUSION: The evidence mapped from studies that evaluated OAM adherence in women with BC indicates that nonadherence to OAMs is common. Applying context-specific standardized measures to assess adherence and facilitators or strategies targeting the identified barriers can optimize adherence and treatment outcomes. Effective interventions to improve adherence are limited. Therefore, further empirical and interventional studies in Africa are required to enhance the evidence.

An assessment on the implementation of same day antiretroviral therapy initiation in eThekwini clinics, KwaZulu-Natal, South Africa.

The World Health Organization (WHO) recommends same-day initiation (SDI) of antiretroviral therapy (ART) for all individuals diagnosed with HIV irrespective of CD4+ count or clinical stage. Implementation of program is still far from reaching its goals. This study assessed the level of implementation of same day ART initiation. A longitudinal study was conducted at four primary healthcare clinics in eThekwini municipality KwaZulu-Natal. Data was collected between June 2020 to October 2020 using a data extraction form. Data on individuals tested HIV positive, number of SDI of ART; and clinicians working on UTT program were compiled from clinic registers, and Three Interlinked Electronic Registers.Net (TIER.Net). Non-governmental organisations (NGO) supporting the facility and services information was collected. Among the 403 individuals who tested HIV positive, 279 (69.2%) were initiated on ART on the same day of HIV diagnosis from the four facilities. There was a significant association between health facility and number of HIV positive individuals initiated on SDI (chi-square=10.59; P-value=0.008). There was a significant association between facilities with support from all NGOs and ART SDI (chi-square=10.18; P-value=0.015. There was a significant association between staff provision in a facility and SDI (chi-square=7.51; P-value=0.006). Urban areas clinics were more likely to have high uptake of SDI compared to rural clinics (chi-square=11,29; P-value=0.003). Implementation of the Universal Test and Treat program varies by facility indicating the need for the government to monitor and standardize implementation of the policy if the program is to yield success.

Barriers and facilitators to Water, Sanitation and Hygiene (WaSH) practices in Southern Africa: A scoping review.

A healthy and a dignified life experience requires adequate water, sanitation, and hygiene (WaSH) coverage. However, inadequate WaSH resources remain a significant public health challenge in many communities in Southern Africa. A systematic search of peer-reviewed journal articles from 2010 -May 2022 was undertaken on Medline, PubMed, EbscoHost and Google Scholar from 2010 to May 2022 was searched using combinations of predefined search terms with Boolean operators. Eighteen peer-reviewed articles from Southern Africa satisfied the inclusion criteria for this review. The general themes that emerged for both barriers and facilitators included geographical inequalities, climate change, investment in WaSH resources, low levels of knowledge on water borne-diseases and ineffective local community engagement. Key facilitators to improved WaSH practices included improved WaSH infrastructure, effective local community engagement, increased latrine ownership by individual households and the development of social capital. Water and sanitation are critical to ensuring a healthy lifestyle. However, many people and communities in Southern Africa still lack access to safe water and improved sanitation facilities. Rural areas are the most affected by barriers to improved WaSH facilities due to lack of WaSH infrastructure compared to urban settings. Our review has shown that, the current WaSH conditions in Southern Africa do not equate to the improved WaSH standards described in SDG 6 on ensuring access to water and sanitation for all. Key barriers to improved WaSH practices identified include rurality, climate change, low investments in WaSH infrastructure, inadequate knowledge on water-borne illnesses and lack of community engagement.

Factors Influencing Rapid Antiretroviral Therapy Initiation at Four eThekwini Clinics, KwaZulu-Natal, South Africa.

Timely uptake of Antiretroviral therapy considerably improves the health of people living with the Human Immunodeficiency virus. We conducted a cross-sectional study of newly HIV diagnosed individuals in four clinics in eThekwini municipality, KwaZulu-Natal. Data was collected between June 2020 and December 2020. Participants completed an interviewer-administered questionnaire after HIV testing, on the day of HIV diagnosis. We evaluated factors influencing uptake of same-day ART initiation in eThekwini clinics, KwaZulu Natal, South Africa. Demographic information, health status, sexual behaviour, knowledge of universal test and treat (UTT), ART initiation uptake, and disclosure data was collected. Among the 403 participants, same-day initiation (SDI) was 69.2% (n = 279). We observed the number of sexual partners (aOR 0.35; 95% CI 0.15-0.81), HIV status of the partner (aOR 5.03; 95% CI 2.74-9.26) and knowledge of UTT (aOR 1.97; 95% CI 1.34-2.90) were identified as major factors influencing uptake of same-day ART initiation. More strategies are needed to achieve the SDI uptake within the framework of UTT.

Modeling factors critical for implementation of precision medicine at health systems-level: an IRT approach.

BACKGROUND: Through recent advances in omics technologies, precision medicine (PM) promises to fundamentally change the way we approach health, disease and illness. Imperative applications of omics-based biomarkers are gradually moving from research to clinical settings, with huge long-term clinical and public health implications. Whereas much of research in PM is mainly focused on basic biomedical discoveries, currently there is little research on the clinical implementation of omics biomarkers, especially at health systems level. AIM AND METHODS: This study investigated the application of multidimensional item response theory (IRT) models to validate a hypothesized PM implementation measurement model. This is a contribution to PM implementation at health systems level. Data obtained through an item-sort procedure involving 496 observations from 124 study participants formed the basis of a 22-item PMI measurement model. CONCLUSION: Statistical significance of the bifactor model suggests PM implementation may have to be examined using factors that reflect a single common underlying implementation construct, as well as factors that reflect unique variances for the identified four content-specific factors.

Training, Attitudes, and Practice (TAP) among healthcare professionals in the Nelson Mandela Bay municipality, South Africa: A health promotion and disease prevention perspective.

BACKGROUND: Healthcare professionals (HCPs) play a pivotal role in ensuring access to quality healthcare of patients. However, their role in health promotion (HP) and disease prevention (DP) has not been fully explored. This study aimed at determining how training, attitude, and practice (TAP) of HCPs influence their practice of HP and DP. METHODS: Data on TAP regarding HP and DP were collected from 495 HCPs from twenty-three hospitals in the study area using a standardized questionnaire. Bivariate, univariate, and multivariate analyses were conducted to describe how the TAP of HCPs influence their HP and DP practices. The analysis was further desegregated at the three levels of healthcare (primary, secondary and tertiary levels). RESULTS: Most of the medical doctors 36.12% (n = 173), registered nurses 28.39% (n = 136), and allied health professionals (AHPs) 11.27% (n = 54) indicated the absence of coordinated HP training for staff in their facilities. Similarly, 32.93% (n = 193) of the HCPs, indicated having participated in HP or DP training. Among those that had participated in HP and DP training, benefits of training were positive behaviour, attributions, and emotional responses. When compared at the different levels of healthcare, enhanced staff satisfaction and continuing professional development for HP were statistically significant only at the tertiary healthcare level. Multivariate analysis showed a likelihood of reduced coordinated HP training for staff among medical doctors (Coef 0.15; 95% CI 0.07-0.32) and AHPs (Coef 0.24; 95% CI 0.10-0.59) compared to nurses. Furthermore, medical doctors (Coeff: 0.66; 95% CI: 0.46-0.94) were less likely to agree that HCPs should model good health behavior to render HP services as compared to nurses. CONCLUSION: Training in HP and DP empowers HCPs with the requisite knowledge and attitude necessary for effective practice. Several HCPs at different levels of care had limited knowledge of HP and DP because of inadequate training. We recommend a strategy aimed at addressing the knowledge and attitudinal gaps of HCPs to ensure effective HP and DP services to patients.

Factors influencing uptake of schistosomiasis research findings in ingwavuma area, uMkhanyakude District, Kwazulu-Natal, South Africa.

BACKGROUND: Research uptake is concerned with spreading ideas across multiple levels of the community. Barriers such as poverty, lack of infrastructure, illiteracy and culture prevent information sharing in arid rural areas of sub-Saharan Africa. OBJECTIVE: This study explores the factors influencing schistosomiasis research uptake and the available channels for the uptake of research findings from a transdisciplinary and eco-health research project on schistosomiasis in Ingwavuma area, uMkhanyakude district, KwaZulu-Natal province in South Africa. METHODS: This case study conducted in 2017 involved 78 primary school children and 73 heads of household recruited through convenience and purposive sampling. Data were collected through focus group discussions, then transcribed and analysed by the researcher using thematic analysis. RESULTS: Factors such as poor knowledge, water and sanitation problems, and lack of sufficient health workers hindered the uptake of schistosomiasis research findings. Participants recommended several platforms to share schistosomiasis research findings with the community, including: door to door visits; social gatherings such as sports events, talent shows, and religious gatherings; mass media platforms such as radio and television; social media platforms such as WhatsApp, Facebook and Twitter; and printed media such as posters, booklets and pamphlets. CONCLUSIONS: There is a need to train health workers and peer educators in this area of South Africa to educate people about schistosomiasis infection, screening and treatment through home visits or social events. Schistosomiasis research findings must be synthesised and packaged in different forms for dissemination via multimedia media-based communication channels.

Enablers and hindrances to health promotion and disease prevention practices among healthcare workers in Nelson Mandela Bay Municipality, South Africa.

Health promotion (HP) and disease prevention (DP) practices among healthcare workers (HCWs) are key to achieving universal health coverage. This study identified HP and DP enablers and hindrances and compared them at different healthcare levels in Nelson Mandela Bay Municipality, South Africa. An exploratory cross-sectional study using a structured questionnaire was conducted among HCWs (n = 501) from 23 hospitals. Bivariate and multinomial regression were used to analyze the data. The highest number of participants (70.46%; n = 353) were from tertiary hospitals. Thirteen and Eight categories of enablers and hindrances respectively were identified. Of these, eleven enablers and six hindrances of HP and DP were associated with tertiary hospitals; no enabler was identified at both primary and secondary while one hindrance was associated with primary level of health care. Collaboration among disciplines and organizations (Coeff: 2.16, 95% CI: 1.28-3.66) and programme planning (Coeff: 0.375, 95% CI: 0.23-0.62) were the predictors of HP and DP among medical doctors, while staff induction training (Coeff: 0.62, 95% CI: 0.40-0.95) and performance appraisal (Coeff: 1.86, 95% CI: 1.16-2.98) were the enablers among allied health workers. On the other hand, 'facility promoting treatment more than prevention' (Coeff: 2.03, 95% CI: 1.30-3.14) and 'practice guidelines incorporating HP' (Coeff: 2.79, 95% CI: 1.66-4.70) were the predictors of HP and DP hindrances among medical doctors and allied health workers respectively. Our work indicates the need for an operational strategy designed considering enabling and hindering factors to HP and DP practices for empowering HCWs and enhancing health outcomes.

Interleukin-13 rs1800925/-1112C/T promoter single nucleotide polymorphism variant linked to anti-schistosomiasis in adult males in Murehwa District, Zimbabwe.

BACKGROUND: Chronic schistosomiasis is predominantly induced through up-regulation of inflammatory cytokines such as interleukin (IL)-13. IL-13 may contribute to the disease outcomes by increasing eosinophil infiltration thereby promoting fibrosis. IL-13 may act as an immunosuppressive inflammatory cytokine that may promote carcinogenesis and also may offer protection against schistosomiasis thereby reducing risk of schistosome infections. Our study evaluated the frequency of the IL-13 rs1800925/-1112 C/ T promoter single nucleotide polymorphisms (SNPs) among schistosomiasis infected individuals and assessed the association of the variants on IL-13 cytokine levels. We also investigated IL-13 rs1800925 polymorphisms on prostate-specific antigen levels as an indicator for risk of prostate cancer development. METHODOLOGY: The study was cross-sectional and included 50 schistosomiasis infected and 316 uninfected male participants residing in Murehwa District, Zimbabwe. IL-13 rs1800925 SNPs were genotyped by allele amplification refractory mutation system-polymerase chain reaction. Concentrations of serum prostate-specific antigens and plasma IL-13 were measured using enzyme-linked immunosorbent assay. RESULTS: Frequencies of the genotypes CC, CT and TT, were 20%, 58% and 22% in schistosomiasis infected, and 18.3%, 62.1% and 19.6% in uninfected participants with no statistical differences. There were significantly (p<0.05) higher IL-13 cytokine levels among both infected and uninfected participants with the genotypes CC and CT; median 92.25 pg/mL and 106.5 pg/mL, respectively, compared to TT variant individuals; 44.78 pg/mL. Within the schistosomiasis uninfected group, CC and CT variants had significantly (p<0.05) higher IL-13 levels; median 135.0 pg/mL and 113.6 pg/mL, respectively compared to TT variant individuals; 47.15 pg/mL. Within the schistosomiasis infected group, CC, CT and TT variant individuals had insignificant differences of IL-13 level. Using logistic regression, no association was observed between prostate-specific antigen levels, IL-13 cytokine levels and IL-13 rs1800925 variants (p>0.05). CONCLUSION: IL-13 rs1800925 C variant individuals had the highest IL-13 cytokine levels among the schistosomiasis uninfected suggesting that they may be protective against Schistosoma infections. There was no association between IL-13 concentrations or IL-13 rs1800925 variants and risk of prostate cancer indicating that IL-13 levels and IL-13 rs10800925 may not be utilised as biomarker for risk of prostate cancer in schistosome infections.

Consulting the Community on Strategies to Strengthen Social Capital for Community Disease Control.

Excluding communities in planning and implementing research maximizes internal risks that are otherwise visible and avoidable when there is adequate community consultation. Communities might not meaningfully use research results if majority of the researched people have minimal or no participation in information generation and dissemination. However, effective participation of researched communities in research is key to transferring knowledge to action. Using a qualitative approach, the study identified barriers to, and relevant strategies for improving health research uptake, particularly for schistosomiasis (commonly known as bilharzia) in the Ingwavuma area, uMkhanyakude District of KwaZulu-Natal. Data was collected through modified ethnography using participant observation, focus group discussions, unstructured in-depth interviews, and ethnographic conversational interviews. Results reveal that research uptake is inhibited by reduced opportunities for habitual interaction between residents, a paucity of innovative and inclusive health education activities and unsafe recreational facilities. The community's strategies on strengthening social capital for disease control include using existing social systems and power hierarchies to mobilise and organise and using the performing arts to facilitate habitual interaction and knowledge sharing. The study recommends a community consultation flow which facilitates openness about the benefits and the community's role in research, a pre-condition for community wide efforts in local disease prevention and control.

The evolution and adoption of World Health Organization policy guidelines on antiretroviral therapy initiation in sub-Saharan Africa: A scoping review.

BACKGROUND: Despite past and present global interventions, the human immunodeficiency virus (HIV) pandemic remains a public health problem in low- and middle-income countries (LMICs). The World Health Organization (WHO) has assisted these countries by providing antiretroviral therapy (ART) policies for adoption and adaptation to local needs. OBJECTIVES: This article describes the response of countries in sub-Saharan Africa (SSA), to the WHO's changing CD4-threshold ART-initiation recommendations of the past two decades. METHODS: Relevant articles published in international peer-reviewed journals were accessed via the following search engines: PubMed, Google Scholar, Cochrane, Embase and EBSCOhost. The study's inclusion criteria were articles published in the English language between 2000 and 2019 that highlighted changes to the CD4 ART-initiation threshold and that focused on the WHO's 'commencement of ART' policy guidelines. Sixteen studies (n = 16) from SSA were identified and included in this review: four are cross-sectional, four deal with cost-effectiveness, four are retrospective, one is a randomised trial and three are observational studies. Only studies conducted in SSA were assessed. RESULTS: Four themes emerged: (1) adoption of the WHO CD4-ART-initiation policy by SSA countries, (2) timely implementation of the changing guideline initiation policy in the region, (3) barriers and facilitators encountered in the implementation of the changing guidelines and (4) description of similarities in policy implementation at country level from 2002 to 2019. Regional studies - cross-sectional, observational, retrospective, cost-effectiveness and randomised have described greater access to ART in SSA. However, barriers remain. The most common barriers to the timely implementation of 'new' ART-initiation guidelines were economic constraints, drug stock-outs, delays in obtaining baseline blood-test results and staff shortages. CONCLUSION: Although countries in SSA have adopted the WHO-ART-CD4 initiation-threshold policy guidelines, implementation has seldom occurred in a timely manner. Barriers have been identified. Whilst a small number of countries have implemented recommendations promptly, for many, the barriers still require to be overcome.

Association of schistosomiasis and risk of prostate cancer development in residents of Murehwa rural community, Zimbabwe.

BACKGROUND: Prostatic male genital schistosomiasis and prostate cancer co-existence cases are uncommon however, some studies have indicated that schistosomiasis may trigger development of prostate cancer regardless of age. Schistosomiasis is a public health problem in sub-Saharan Africa and may account for some undocumented cases of schistosomiasis prostatic cancer in schistosome endemic rural communities. It is against this background that we investigated the association between schistosomiasis and risk of prostate cancer development in residents of Murehwa Community, a schistosomiasis endemic area. METHODOLOGY: We conducted a cross sectional study involving 366 men residing in Murehwa District, Zimbabwe. Schistosoma haematobium and S. mansoni infection was diagnosed using urine filtration and Kato Katz techniques, respectively. Haematuria was detected using urinalysis reagent strip test. A structured questionnaire was used to obtain history of schistosomiasis infection among study participants. Risk of prostate cancer development was assessed by measuring prostate-specific antigen levels in serum using the ELISA. RESULTS: Prevalence of S. haematobium and S. mansoni infection was 12.3% and 1.4%, respectively. Individuals with schistosomiasis had higher prostate-specific antigen levels (mean 1.208 ± SD 1.557 ng/mL) compared to those without schistosomiasis (mean 0.7721 ± SD 1.173 ng/mL; p < 0.05). Older individuals > 50 years had higher prostate specific antigen levels (mean 0.7212 ± SD 1.313 ng/mL) compared to individuals < 50 years old (mean 0.4159 ± SD 0.8622 ng/mL; p < 0.05). Prostate-specific antigen levels log10 (mean 0.2584 ± SD 0.2128 ng/mL) and were associated to S. haematobium infection intensity log10 (mean 1.121 ± SD 0.5371 eggs/10 mL), r(s) = - 0.3225, p < 0.05. There was a correlation between prostate-specific antigen levels log10 (mean 0.2246 ± SD 0.1858 ng/mL) and S. haematobium infection intensity log10 (mean 1.169 ± SD 0.5568 eggs/10 mL) among participants with a history of schistosomiasis infection (r(s) = - 0.3520; p < 0.05). There was no correlation between prostate-specific antigen levels of > 4 ng/mL (mean 5.324 ± SD1.568 ng/mL) and schistosome eggs log10 (mean 1.057 ± SD 0.6730 eggs/10 mL; p > 0.05). CONCLUSION: Urogenital schistosome infections and history of schistosome infections were associated with prostate specific antigen levels, an indicator for risk of prostate cancer. Therefore, S. haematobium schistosome egg burden was associated with the risk of prostate cancer development in adult males residing in Murehwa District, Zimbabwe.

Leveraging implementation science to improve implementation outcomes in precision medicine.

BACKGROUND AND PURPOSE: Introduction of omics technologies in clinical practice means increased use of validated biomarkers, through precision medicine (PM). Although implementation science (IS) affords an array of theoretical approaches that can potentially explain PM intervention uptake, their relevance and applicability in PM implementation has not been empirically tested. This article identifies and examines existing implementation frameworks for their applicability in PM, demonstrating how different IS theories can be used to generate testable implementation hypotheses in PM. METHODS: A three-step methodology was employed to search and select implementation models: a scoping search in Google Scholar produced 15 commonly used models in healthcare; a systematic search in PUBMED and Web of Science using the names of each model as keywords in search strings produced 290 publications for screening and abstraction; finally, a citation frequency search in the 3 databases produced most cited models that were included in the narrative synthesis. RESULTS: Main concepts and constructs associated with each of the 15 models were identified. Four most cited frameworks in healthcare were: REAIM, CFIR, PRISM and PARiHS. Corresponding constructs were mapped and examined for potential congruence to PM. A generalized PM implementation conceptual framework was developed showing how omics biomarker uptake relates to their evidence base, patient and provider engagement and Big data capabilities of involved organizations. CONCLUSION: We demonstrated how implementation complexities in PM can be addressed by explicit use of implementation theories. The work here may provide a reference for further research of empirically testing and refining the identified implementation constructs.

The mediating effects of public genomic knowledge in precision medicine implementation: A structural equation model approach.

Precision medicine emphasizes predictive, preventive and personalized treatment on the basis of information gleaned from personal genetic and environmental data. Its implementation at health systems level is regarded as multifactorial, involving variables associated with omics technologies, public genomic awareness and adoption tendencies for new medical technologies. However, interrelationships of the various factors and their synergy has not been sufficiently quantified. Based on a survey of 270 participants involved in the use of molecular tests (omics-based biomarkers, OBMs), this study examined how characteristics of omics biomarkers influence precision medicine implementation outcomes (ImO) through an intermediary factor, public genomic awareness (represented by User Response, UsR). A structural equation modelling (SEM) approach was applied to develop and test a 3 latent variable mediation model; each latent variable being measured by a set of indicators ranging between three and six. Mediation analysis results confirmed a partial mediation effect (an indirect effect represented as the product of paths 'a' and 'b' (a*b)) of 0.36 at 90% confidence level, CI = [0.03, 9.94]. Results from the individual mediation paths 'a' and 'b' however, showed that these effects were negative(a = -0.38, b = -0.94). Path 'a' represents the effect of characteristics of OBMs on the mediator, UsR; 'b' represents the effect of the mediator, UsR on implementation outcomes, ImO, holding OBMs constant. The results have both theoretical and practice implications for biomedical genomics research and clinical genomics, respectively. For instance, the results imply better ways have to be devised to more effectively engage the public in addressing extended family support for extended family cascade screening, especially for monogenic hereditary conditions like BRCA-related breast cancer and colorectal cancer in Lynch syndrome families. At basic biomedical research level, results suggest an integrated biomarker development pipeline, with early consideration of factors that may influence biomarker uptake. The results are also relevant at health systems level in indicating which factors should be addressed for successful.

Levels and Correlates of Physical Activity in Rural Ingwavuma Community, uMkhanyakude District, KwaZulu-Natal, South Africa.

Physical activity, among others, confers cardiovascular, mental, and skeletal health benefits to people of all age-groups and health states. It reduces the risks associated with cardiovascular disease and therefore, could be useful in rural South Africa where cardiovascular disease (CVD) burden is increasing. The objective of this study was to examine levels and correlates of physical activity among adults in the Ingwavuma community in KwaZulu-Natal (KZN). Self-reported data on physical activity from 392 consenting adults (female, n = 265; male, n = 127) was used. We used the one-sample t-test to assess the level of physical activity and a two-level multiple linear regression to investigate the relationship between total physical activity (TPA) and independent predictors. The weekly number of minutes spent on all physical activities by members of the Ingwavuma community was 912.2; standard deviation (SD) (870.5), with males having 37% higher physical activity (1210.6 min, SD = 994.2) than females (769.2, SD = 766.3). Livelihood activities constituted 65% of TPA, and sport and recreation contributed 10%. Participants without formal education (20%), those underweight (27%), and the obese (16%) had low physical activity. Notwithstanding this, in general, the Ingwavuma community significantly exceeded the recommended weekly time on physical activity with a mean difference of 762.1 (675.8-848.6) minutes, t (391) = 17.335, p < 0.001. Gender and age were significant predictors of TPA in level 1 of the multiple regression. Males were significantly more active than females by 455.4 min (ß = -0.25, p < 0.001) and participants of at least 60 years were significantly less active than 18-29-year-olds by 276.2 min (ß = -0.12, p < 0.05). Gender, marital status, and health awareness were significant predictors in the full model that included education level, employment status, body mass index (BMI), and physical activity related to health awareness as predictors. The high prevalence of insufficient physical activity in some vulnerable groups, notably the elderly and obese, and the general poor participation in sport and recreation activities are worrisome. Hence we recommend health education interventions to increase awareness of and reshape sociocultural constructs that hinder participation in leisure activities. It is important to promote physical activity as a preventive health intervention and complement the pharmacological treatment of CVDs in rural South Africa. Physical activity interventions for all sociodemographic groups have potential economic gains through a reduction in costs related to the treatment of chronic CVD.

The healthcare seeking behaviour of adult patients with asthma at Chitungwiza Central Hospital, Zimbabwe.

BACKGROUND: Although asthma is a serious public health concern in Zimbabwe, there is lack of information regarding the decision to seek for healthcare services among patients. This study aimed to determine the health care seeking behaviour of adult patients with asthma attending Chitungwiza Central Hospital in Zimbabwe. METHODS: A cross-sectional study was conducted among 400 patients with asthma. A questionnaire with four thematic areas (i) patients' demographic characteristics, (ii) types of health seeking behaviours (iii) knowledge of asthma treatment and (iv) attitudes on asthma treatment was used. RESULTS: We determined the sequence of remedial action that people undertake to rectify perceived ill health commonly referred to as health care seeking behaviours in 400 adult patients with asthma. This behaviour was considered good if the patient sought care at the hospital/clinic and or private practitioners. Poor health seeking behaviour was adjudged if patients sought no treatment, self-treated or resorted to traditional or faith healers for care.The majority 261(65.3%) of the study participants were females mainly between ages 29-39 years who lived in the urban setting. Distance to health facility, perception of supportive roles of healthcare providers, perceived good quality of service and knowledge of asthma complications were key determinants for health seeking behaviour. The results showed that majority 290 (72.5%) reported good health seeking behaviour. The correlates of good health seeking behaviour included financial capacity to pay for medical care [OR: 0.50 (CI: 0.31-0.83); p = 0.008)] and receiving good quality of asthma treatment [OR: 0.59 (CI: 0.37-0.93); p = 0.03)]. The inability to voluntarily seek own asthma treatment [OR: 1.68 (CI: 1.05-2.70); p = 0.03) was a significant risk factor (68% more likely) for poor health seeking behaviour. CONCLUSIONS: We concluded that prior to scaling up asthma treatment programmes in Zimbabwe, there is need to address, individual-level, community-level and health service level barriers to health seeking among asthma patients.

Contextual and Psychosocial Factors Influencing the Use of Safe Water Sources: A Case of Madeya Village, uMkhanyakude District, South Africa.

Background: Schistosomiasis is a public health problem that affects over 240 million people worldwide. It is mostly prevalent in tropical and sub-tropical areas among communities with limited access to clean water and adequate sanitation. This study was conducted in uMkhanyakude District in rural South Africa, where water resources are limited. In this community, individuals frequently come into contact with freshwater bodies for various reasons. The objective of the study was to identify critical contextual and psychosocial factors for behaviour change to reduce risk of schistosomiasis transmission in Madeya Village, uMkhanyakude district. Methods: Structured household interviews were held with 57 primary caregivers to assess their thoughts and attitudes towards collecting water from a safe source. We used the Risk, Attitude, Norm, Ability, and Self-regulation model (RANAS) to estimate the intervention potential for each factor by analysing differences in means between groups of current performers and nonperformers who use safe water sources. Results: The subscale vulnerability belonging to the risk factor on the RANAS was scored as low. Furthermore, attitudinal factors towards the use of safe water sources were found to be low. Ability factors (confidence in performance and confidence in recovery) towards the use of safe water sources were low as well, indicating that these factors should be the target of the intervention in the study area. Discussion: Based on this study, it is recommended that a community-based empowerment intervention strategy it appropriate. The strategy should prompt behavioural practice and public commitment, use persuasive language to boost self-efficacy and target younger low-income caregivers between 18 and 35 years of age.