Fast-track interventions for HIV and AIDS epidemic control among key populations: A rapid review.

BACKGROUND: Targeted interventions for key populations remain critical for realisation of epidemic control for human immunodeficiency virus (HIV) infection because of the causal relationship between HIV infection in the general population and among key population groups. AIM: To consolidate evidence on the fast-track interventions towards achieving HIV epidemic control among key populations. METHODS: A rapid scoping review was conducted using the methodological framework by Arksey and O' Malley. The Population, Intervention, Context and Outcome (PICO) framework was used to identify relevant studies using key words with Boolean operators in electronic data bases, namely CINHAL, Web of Science, Psych Info and Sabinet. Studies were extracted using a modified data extraction tool, and results were presented narratively. RESULTS: A total of 19 articles were included in this review. Most articles were primary studies (n = 17), while another involved the review of existing literature and policies (n = 2) and routinely collected data (n = 1). Most studies were conducted in the United States of America (n = 6), while another were conducted in China, Kenya, Botswana, South Africa and Mozambique. All studies revealed findings on tested interventions to achieve HIV epidemic control among key populations. CONCLUSION: Effective interventions for HIV epidemic control were stand-alone behavioural preventive interventions, stand-alone biomedical preventive strategies and combination prevention approaches. Furthermore, the findings suggest that effective activities to achieve HIV epidemic control among key populations should be centred around prevention.Contribution: The findings of this study have policy and practice implications for high HIV burden settings such as South Africa in terms of interventions to facilitate realisation of the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 targets, thereby contributing to HIV epidemic control.

Fast-track interventions for HIV and AIDS epidemic control among key populations: A rapid review

Background: Despite measures put in place to combat teenage pregnancy, the rate remains high. Community health workers (CHWs) are a cadre of health workers that can help put measures in place to reduce teenage pregnancy in the communities in which they live and work. Aim: This article aims to gain a deeper understanding of CHWs' perceptions regarding teenage pregnancy in the rural districts of Limpopo province. Methods: An exploratory qualitative study approach was employed to collect data from CHWs in two rural districts of Limpopo. A non-probability purposive sampling approach was used to choose 81 CHWs. Eight focus group discussions (FGDs) were organised, and audio recorded to collect data from participants. The discussions were 2­3 h long and conducted in English, and data saturation was attained by the fifth FGDs. Results: An eight-step tech's content analysis approach was employed to deductively code, analyse and summarise data into themes. Three themes emerged: the prevalence of teenage pregnancy in rural villages, factors contributing to teenage pregnancy and challenges faced by CHWs when dealing with teenage pregnancy. Conclusion: The study's findings revealed that CHWs face challenges in their communities when offering appropriate teen pregnancy services and CHWs believe that teen pregnancy numbers remain high. There is a significant barrier in combating teenage pregnancy; if contraceptives are not acceptable to the community, the only solution and option for combating teenage pregnancy is abstinence. Contribution: The CHWs presented their insights of teenage pregnancy in rural communities. The outcomes of this study could help clinical practise, schools, communities, youth-friendly services, policymakers and other non-governmental organisations reduce teenage pregnancy.

The Effect of Melasma on the Quality of Life in People with Darker Skin Types Living in Durban, South Africa.

Melasma is a common skin disorder of acquired hyperpigmentation that appears commonly on the face. Although asymptomatic, melasma causes psychosocial and emotional distress. This study aimed to assess melasma's severity on people with darker skin types, evaluate the effects of melasma on the quality of life (QoL), and establish QoL predictors in affected individuals. This was a cross-sectional analytic study that enrolled 150 patients from three private dermatology clinics in Durban, South Africa who were diagnosed with melasma. The severity of melasma alongside QoL were measured using a melasma area and severity index (MASI) score and melasma quality of life scale (MELASQoL), respectively. The associations among factors and QoL were explored using multivariable methods and stepwise regression analysis. p-values less than 0.05 were considered significant. Enrolled patients were predominantly females (95%), of which 76% were of black African ethnicity, 9% were of Indian ethnicity, and 15% had mixed ancestry, with an average age of 47.30 years. Family history revealed that 61% had no prior melasma cases, while 39% had affected relatives, most commonly mothers (41%). The cheeks were the most common site for melasma. MASI score of Masi (ß = 0.209, t = 2.628, p < 0.001), the involvement of cheeks (ß = -0.268, t = -3.405, p < 0.001), level of education (ß = -0.159, t = -2.029, p = 0.044), and being menopausal (ß = -0.161, t = -2.027, p = 0.045) were found to be predictors of QoL. A regression model was created to forecast MELASQoL using these four predictors. This equation's significance lies in its ability to enable the remote assessment of MELASQoL based on these four variables. It offers a valuable tool for researchers and medical professionals to quantitatively and objectively evaluate the impact of melasma on an individual's quality of life.

Melasma in people with darker skin types: a scoping review protocol on prevalence, treatment options for melasma and impact on quality of life.

BACKGROUND: Melasma is one of the most encountered dermatoses in dermatology and skin care clinics. It is a challenging chronic, recurrent condition associated with hyperpigmentation. Its aetiology is poorly understood. Melasma affects all races and gender but is more prevalent in women with darker skin types. Being a facial lesion, melasma has a severe impact on quality of life due to its disfigurement. While many modalities of treatment for melasma exists, unfortunately, effectiveness and safety remain a huge concern. Treatment modalities are variable and often unsatisfactory. The objective of this scoping review is to systemically map available evidence from literature regarding melasma on people with darker skin types, garner insight as to how melasma affects the quality of life and begin to investigate and gain understanding on effectiveness of different treatments used for melasma. METHODS: A scoping review guided by Arksey and O'Malley's framework, the enhancements and recommendations of Levac, Colquhoun and O'Brien, Daudt and associates and the 2015 Johanna Briggs Institute's guidelines will be conducted. Systematic electronic searches of databases and search engines will include Scopus, PubMed, CINAHL Complete, Cochrane, Science Direct, and Web of Science which will be conducted to attain published peer-reviewed articles of all study designs excluding reviews and grey literature. All literature that meets the inclusion criteria, research question and sub-question will be included in this review. All the retrieved literature will be exported to an Endnote X20 library. Quality appraisal of the included articles will be conducted using the mixed methods appraisal tool (MMAT) 2018 version. DISCUSSION: We anticipate mapping relevant literature on the melasma, investigating the effectiveness of treatment options of melasma as well as evaluating its association with quality of life in people with darker skin types. This study is likely to reveal research gaps, which could guide future implementation research on melasma treatment interventions. SYSTEMATIC REVIEW REGISTRATION: This protocol has been registered a priori with OSF and is accessible on this link: https://osf.io/ru3jc/ .

An Investigation into the Acute and Subacute Toxicity of Extracts of Cassipourea flanaganii Stem Bark In Vivo.

The conventional use of medicinal plants is in part based on the widespread belief that plant crude extracts are non-toxic. In South Africa, traditional preparations of Cassipourea flanaganii used to treat hypermelanosis have accordingly been regarded by many as non-toxic. Whether that is so impacts on the potential of bark extracts to be developed as a commercial drug to treathypermelanosis, given their documented capacity to inhibit tyrosinase activity. Our study investigated the acute and subacute toxicity of the methanol extract of C. flanaganii bark in rats. Wistar rats were randomly assigned into different treatment groups. The rats received a daily oral gavage of crude extract for acute and subacute toxicity tests. Haematological, biomechanical, clinical and histopathology examinations were carried out to evaluate the possible toxicity of C. flanaganii. The results were subjected to the Student's t-test and ANOVA. For both acute and subacute toxicity, there was no statistical difference between the groups. There were no clinical or behavioral signs of toxicity observed in the rats. No treatment-related gross pathology lesions and no histopathology were observed. The findings of this study demonstrate the absence of acute or subacute toxicity after oral treatment with C. flanaganii stem bark extracts in Wistar rats at the levels administered. Chemical profiling of the total extract using LC-MS tentatively identified eleven (11) compounds as the major chemical constituents.

Evaluating the effectiveness of laser hair reduction using a home use laser in comparison to a Diode laser.

BACKGROUND: Lasers of different wavelengths have been developed for use in permanent hair reduction. An increase in the manufacturing of home-use laser hair removal devices allows for these treatments to be performed in the comfort of your own home at an affordable cost. OBJECTIVE: To evaluate the effectiveness of permanent hair reduction using a Diode laser in comparison to the Silk'n™ Flash and Go Lux (475-1200 nm) home-use laser. METHODS: Fifteen females received six axillae laser hair removal treatments at two to four-week intervals using either a professional laser or home-use laser device. Photographs and hair counts were taken before each treatment and at a three week follow up. A T-test was used to evaluate statistical significance, and regression analysis to determine a difference in the effects. Pain scores and side effects were recorded by a visual analogue scale in a satisfaction questionnaire. RESULTS: The professional laser showed an overall hair reduction of 85% on the right axilla and 88% on the left axilla. The home-use laser showed an overall reduction of 52% on the right axilla and 46,3% on the left axilla. Mild side effects were experienced for both laser devices. There were no serious adverse effects reported, safety features are effective to a certain extent. CONCLUSION: The Flash & Go Lux home-use laser can effectively reduce hair at a slower rate than the Diode laser. The home-use laser device offers protection against accidental exposure to light and use on darker skin types. Risks of retinal damage due to long-term exposure to home-use laser light are still cause for concern.

Analysis of Three Species of Cassipourea Traditionally Used for Hypermelanosis in Selected Provinces in South Africa.

There is a growing demand and use of herbal cosmetics for skin purposes due to their perceived safety when applied to the skin. Three Cassipourea species commonly known as "ummemezi" are used interchangeably by women in rural areas of Eastern Cape and KwaZulu-Natal provinces to treat hypermelanosis as well as sun protection. We conducted a phytochemical comparison of three Cassipourea species; Cassipourea flanaganii (Schinz) Alston, Cassipourea gummiflua Tul. verticillata (N.E.Br.) J. Lewis and Cassipourea malosana (Baker) Alston by Liquid Chromatography-Mass Spectrometry (LC-MS/MS) analysis in negative mode. The results obtained from the LC-MS/MS yielded a total number of twenty-four compounds of different chemical classes, including fatty acids, steroids, di- and tri-terpenoids, flavonoids, phenolic acids, and eighteen among them were tentatively identified. The LC-MS /MS analysis showed that the three studied Cassipourea extracts contain compounds that have anti-tyrosinase activity and consequently. The presence of these compounds, either in synergy or individually, can be attributed to the anti-tyrosinase effect. Although the traditional names of the species are used interchangeably, they are different, however, they possess similar skin-lightening properties. Despite the recent popularity of modern cosmetic products, plants continue to play an important role in the local cosmetics industry in South Africa's Eastern Cape and KwaZulu-Natal community provinces.

The Feasibility of an Interdisciplinary Approach on the Management of Psoriasis in South Africa.

CONTEXT: Psoriasis is an immune-mediated, inflammatory skin disease associated with comorbidities such as psoriatic arthritis, depression, obesity, and cardiovascular disease. Due to its visibility, psoriasis can induce stress and have a negative impact on a patient's quality of life. Current medical interventions are often ineffective and costly and are associated with undesirable side effects, thus emphasizing the need for innovative approaches to treatment. OBJECTIVE: The study intended to explore the feasibility of an interdisciplinary approach between dermatologists and somatologists in the holistic management of psoriasis. DESIGN: The research team performed a narrative review by searching for scientific articles in the databases Google Scholar, Scopus, PubMed, and Medline, including relevant observational studies, systematic reviews, randomized controlled trials, and meta-analyses on the diagnosis and management of psoriasis. SETTING: The review took place at Durban University of Technology library, Durban, South Africa. RESULTS: Psoriasis is a huge medical burden. It has a negative psychological impact on quality of life. Patients are not satisfied with the current treatment approach and they prefer alternative therapies. Spa therapy could be used in conjunction with medical therapy for the management of psoriasis. Through water or spa therapy, it has been shown that trace elements in mineral waters are absorbed through the skin and perhaps modulate the immune system. CONCLUSIONS: The current review has provided some practical advice on how to manage psoriasis in a holistic manner. Somatology training institutions should consider incorporating Pso Well training in their program, thereby keeping abreast of new developments associated with psoriasis management. MBCT could be added to the set of holistic interventions for patients suffering from psoriasis, particularly those who suffer from poor psychological well-being. Robust clinical tests should be performed to evaluate the effectiveness of treatments, such as integrative patient management between the two professions.

The Management of Melasma on Skin Types V and VI Using Light Emitting Diode Treatment.

OBJECTIVE: This study investigated light emitting diode (LED) treatment for patients with melasma on darker skin types. BACKGROUND: Melasma is a common disfiguring skin condition in women which is difficult to treat and is refractory. The cause of melasma remains unclear. METHODS: In this study, 60 female participants aged between 25 and 60 years, who presented with melasma, were enrolled (n = 39.85). They were purposely assigned to two groups according to their skin types. Both groups received a total of 36 LED light treatments over a period of 9 months. RESULTS: Both subjective and objective results indicated a significant improvement of melasma. Statistical analyses revealed significant improvements in both groups. CONCLUSIONS: The results of this study suggest that LED is effective in managing melasma. These results will provide a basis for future therapeutic use of phototherapy to improve melasma.