Comparison of endothelial function and cardiometabolic profiles of people living with HIV in two South African regions: the EndoAfrica study.

BACKGROUND: People living with HIV (PLWH) are at risk for cardiovascular disease, but regional differences have not been studied in South Africa. We compared endothelial function and cardiometabolic markers in PLWH and HIV-free controls from two distinct South African regions. METHODS: We measured flow-mediated dilation (FMD), cardiometabolic, immunological and viral markers in age- and gender-matched PLWH on antiretroviral therapy (n = 100/group) and HIV-free participants (n = 50/group) in samples from cohort studies in the North West and Western Cape provinces. RESULTS: Endothelial function and cardiometabolic profiles were not worse in PLWH than in HIV-free individuals, and %FMD was not associated with cardiometabolic, viral or immunological markers. PLWH from the North West region had lower %FMD but overall better metabolic profiles. CONCLUSIONS: Ethnic, cultural and socio-economic differences need further investigation to understand the possible protective role of antiretroviral treatment on the vasculature and to direct region-specific HIV and AIDS guidelines in South Africa.

Evaluation of household assessment data collected by community health workers in Cape Town, South Africa.

BACKGROUND: South Africa has implemented ward-based outreach teams as part of re-engineering primary health care with teams of community health workers (CHWs). In Cape Town, such a community-orientated primary care (COPC) approach was developed at four learning sites. Community health workers registered and assessed the households they were responsible for, but a year later the data were not analysed or converted into useful information. The aim was to analyse the household data and evaluate its contribution to a community diagnosis, its quality and any implications for the performance of CHWs. METHODS: This article used descriptive secondary analysis of household data collected by CHWs at three COPC learning sites in Cape Town (Nomzamo, Eastridge and Mamre). RESULTS: Data were analysed for 16 852 people from Eastridge, 1338 people from Mamre and 1008 people from Nomzamo. Data were compared in terms of household composition and demographics, type of dwelling, identification of people on treatment for chronic conditions, identification of health risks (e.g. tuberculosis symptoms, tobacco smoking, missed immunisations, missed vitamin A prophylaxis, need for human immunodeficiency virus (HIV) testing or family planning, pregnant or postnatal, and wound care) and for referrals. CONCLUSION: Household assessment visits have great potential. Data collected is currently of poor quality, inconsistent or not captured, infrequently analysed and not comprehensive. There is a need to introduce an electronic m-health solution to assist the health information system, to revise the contents of the household assessment form and to ensure that CHWs are competent to identify risks and respond appropriately.

Vascular Structure and Inflammation in a South African Population: The SABPA Study.

BACKGROUND AND OBJECTIVE: Inflammation plays a role in the early onset of cardiovascular disease. However, longitudinal studies on this topic, especially in South African populations, are scant. We explored whether early changes in vascular structure are associated with changes in inflammation. METHODS: We investigated 303 South African teachers aged 20-65 years at two intervals, three years apart. Standardised methods were used to determine carotid intima-media thickness (IMT) and cross-sectional wall area (CSWA) as measures of vascular structure, as well as the inflammatory markers soluble urokinase plasminogen activator receptor (suPAR), C-reactive protein (CRP) and interleukin-6 (IL-6) at baseline and follow-up. RESULTS: IMT and CSWA were higher, while CRP was lower at follow-up than at baseline. After adjusting for confounding factors, percent change in IMT was inversely associated with percent change in suPAR (ß = -0.12, p = 0.036; adjusted R2 = 0.16) only, and only in the highest tertile of percent change in suPAR (r = -0.31; p = 0.002). CONCLUSION: The early structural changes observed are not related to higher inflammatory levels in this South African population. Future studies are needed to investigate the possible protective effect of suPAR on early changes in vascular structure, especially with the focus on cardiovascular disease prevention.