South African Journal of Public Health (Southern African Journal of Public Health) aims to bridge the divides between academia, policy and implementation in health systems intervention and reform. We publish papers with recognisable policy impact that draw on robust research and operational experience from both academic and non-academic authors on Population health and Preventive Medicine.
The SAJPH is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Copyright (c) 2026 D Basu https://creativecommons.org/licenses/by-nc/4.0
Bridging the gap - The urgent imperative for dedicated, multidisciplinary adolescent health services in South Africa
Copyright (c) 2025 D Basu https://creativecommons.org/licenses/by-nc/4.0
Factors associated with adherence to HIV treatment among adolescent girls and young women in the Imagine pro- gramme in South Africa: A mixed-methods study protocol
Background. Adherence to antiretroviral therapy (ART) is critical to achieving viral suppression and reducing HIV-related morbidity and transmission. However, consistent adherence remains a challenge, particularly among adolescent girls and young women (AGYW) in sub-Saharan Africa (SSA), an already vulnerable group disproportionately affected by HIV. In SSA, AGYW account for the majority of new infections, and despite widespread availability of ART and ambitious national targets, optimal adherence is not being consistently achieved. Objectives. To identify factors associated with adherence to HIV treatment among AGYW enrolled in the Imagine programme, a school-based HIV and pregnancy prevention intervention implemented in 14 rural schools in North West and KwaZulu-Natal provinces, South Africa (SA). Methods. Employing a mixed-methods design, the cross-sectional study will conduct secondary quantitative analysis of data collected in the Imagine programme. Additionally, primary data will be obtained from in-depth interviews conducted with a subset of participants to explore perceptions, barriers and experiences related to adherence. Quantitative data will be analysed using descriptive statistics and logistic regression to assess associations between adherence and sociodemographic, behavioural and structural factors. Qualitative data will be analysed thematically to provide contextual insights. Conclusion. This study addresses a critical evidence gap by focusing on adherence in a rural AGYW population. The findings are expected to inform both programme implementation and broader adolescent HIV treatment strategies in SA.
Copyright (c) 2026 L Naushin, T Phashe, F Abdullah https://creativecommons.org/licenses/by-nc/4.0
Reviving Preventive Medicine as a clinical specialty in South Africa
Copyright (c) 2025 T Maimela, H Volmink, D Basu https://creativecommons.org/licenses/by-nc/4.0
Applications of GRADE-Adolopment in South African health policy: Assessing affordability in South Africa’s GRADE-Adolopment processes
Background. South Africa’s (SA) progress toward universal health coverage (UHC) is marked by efforts to prioritise primary healthcare and improve access to cost-effective and affordable health services. Central to this reform is the adoption of evidence-based processes, such as Health Technology Assessment (HTA) and the GRADE-Adolopment approach, which support the contextualisation of global clinical guidelines through local epidemiological, health system, and cost data. Despite progress in considering clinical effectiveness and cost-effectiveness, explicit integration of affordability and equity considerations remains limited. This review assessed SA case studies applying the GRADE-Adolopment and Evidence-to-Decision (EtD) frameworks to evaluate how affordability, particularly through budget impact analysis (BIA), has been addressed. Methods. We conducted a review of both published and grey literature from 2015 to May 30 2025, searching PubMed, Scopus, and the websites of the SA National Department of Health and the Council for Medical Schemes, using terms such as ‘GRADE,’ ‘Adolopment,’ ‘South Africa,’ ‘guidelines,’ and ‘affordability.’ Eligible studies included those applying the GRADE or Evidence-to-Decision (EtD) frameworks in the development of guidelines or policies in South Africa. We extracted data on the use of GRADE, EtD domains, and affordability frameworks (including cost-effectiveness analysis, budget impact analysis, equity trade-offs, resource mapping, and feasibility), assessing their impact on policy through comparative analysis. Additionally, we performed inductive thematic analysis to synthesise cross-cutting lessons and barriers related to the integration of affordability within decision-making processes. Results. Across six SA case studies, the integration of affordability assessments within GRADE-Adolopment processes varied considerably. National initiatives demonstrated structured approaches, consistently applying cost-effectiveness and budget impact analyses in guideline development. In contrast, subnational or project-based adaptations often addressed affordability reactively, due to limited data and health economics capacity. Key themes included the reactive nature of affordability considerations, the enabling role of centralised decision-making structures, and challenges from inadequate data and technical expertise. Several case studies highlighted the importance of using transparent, context-specific EtD frameworks to support consistent, equitable, and feasible policy decisions in resource-constrained settings. Conclusion. Affordability was inconsistently integrated into the guideline development processes, with structured assessments more common in nationally led initiatives. Conversely, reactive and informal approaches dominated at subnational levels. Given fiscal constraints, tools such as league tables and expansion pathways could be more effective in prioritising affordable, high-impact interventions. Institutionalising such approaches and strengthening local capacity will support sustainable, evidence-based policy under SA’s National Health Insurance.
Copyright (c) 2026 T D Leong, P Daames https://creativecommons.org/licenses/by-nc/4.0
Reflections on the SAPHPMA symposium – where public health medicine stands today
South African Public Health and Preventive Medicine Association;
Copyright (c) 2025 V Naidoo https://creativecommons.org/licenses/by-nc/4.0
Book Review: Malviya R, Sundram S. (Eds.). Blockchain for Healthcare 4.0: Technology, Challenges, and Applications (1st ed.). CRC Press; 2023
Copyright (c) 2026 R F Mahmoud https://creativecommons.org/licenses/by-nc/4.0
How race, internal migration and gender are associated with consistency in healthcare-seeking behaviour in South Africa: Nationally representative longitudinal evidence from 2008 to 2015
Background. In South Africa (SA), consistently seeking out primary healthcare is more important than ever as the country ages and undergoes epidemiological transition. SA’s most racialised individuals – those identifying as black and coloured – often need to migrate within the country to ensure their families’ economic stability, and internal migrants often experience difficulties in accessing healthcare compared with non-migrants. But gender matters too, as women tend to seek out healthcare more than men throughout the world, and internal migration affects women’s and men’s lives differently in SA. Objectives. To examine differences in the consistency of healthcare-seeking behaviour between internal migrants and non-migrants, among black and coloured residents of SA, by gender. No study in SA to date has been able to examine all three of these elements, despite their important confluence stemming from apartheid and before. Methods. To do so, this article uses data from the first four waves (2008, 2010 - 2011, 2012, and 2014 - 2015) of the National Income Dynamics Study. A total of 6 131 black and coloured men and women aged ≥18 years in 2008 form the analytical sample. Logistic regressions, with panel weights adjusted for respondent loss to follow-up, predict the likelihood that individual respondents will be consistent in seeking health consultations over the four waves as a function of their racialised identity, internal migrant status, and gender. Results. Black residents (compared with coloured) and men (compared with women) have the lowest chances of consistently seeking out healthcare. There is no direct internal migration difference in seeking healthcare, but it is conditional upon racial and gender identity. Conclusion. Black South Africans – especially, but not exclusively, migrant men – do not have the same chances of seeking primary care as their also-racialised coloured counterparts. For population health and clinical efforts, identifying who is at risk of not seeing a doctor is crucial, and this article provides a key update on earlier striking differences in healthcare access between SA’s most racialised groups.
Gender Identity, Healthcare, Longitudinal Analyses, Racial Identity, Migration, South Africa
Copyright (c) 2026 T W Myroniuk https://creativecommons.org/licenses/by-nc/4.0
Estimation of postpartum morbidities and risk factors of women presenting for their first postpartum visit at a midwife obstetric unit in eThekwini, South Africa
Background. Despite reduction of the global maternal mortality ratio by 38% between 2000 and 2017, morbidities during the postpartum period remain the leading cause of maternal death in developing countries. In Africa, most maternal deaths occur during the postpartum period, and deaths during this period are common in South Africa (SA). Objectives. To estimate the incidence of postpartum morbidities and associated risk factors among women attending a community health centre in SA. Methods. A facility-based cross-sectional study was undertaken. Both continuous and categorical variables were described using descriptive statistics. Factors associated with postpartum conditions were determined by logistic regression with adjusted odds ratios (ORs), 95% confidence intervals (CIs) and p-values. Statistical significance was set at p<0.05. Results. A total of 399 postpartum women participated, with a mean age of 26.1 years. The teenage pregnancy rate was 19.3%, the majority fell into the age group 20 - 34 years (66.5%) and were single (70.1%), and 68.4% had no income. Only 30.2% of mothers had planned the index pregnancy. All of them knew their HIV status, and 41.7% were HIV infected. The postpartum morbidity rate was 35.9%. Logistic regression analysis showed that women who had normal vaginal deliveries (NVDs) and were in full-time employment had lower ORs for any postpartum morbidity (OR 0.47; 95% CI 0.26 - 0.86; p=0.014 and OR 0.44; 95% CI 0.21 - 0.88; p=0.022, respectively). Participants with no education had an OR of 3.1 (95% CI 1.21 - 8.15; p=0.019). Conclusion. The high postpartum morbidity rate is comparable to previously reported findings at midwife obstetric units in SA. Women who had no education were at increased risk of postpartum conditions, while full-time employment and NVD had protective effects. Skilled obstetric care and maintenance of strict asepsis during delivery are necessary to prevent common postpartum morbidities. Postnatal care should be improved to address the main risks to mothers, and socioeconomic challenges need to be addressed.
Copyright (c) 2025 A M Hoque, S Buckus, M Hoque, R Hoque https://creativecommons.org/licenses/by-nc/4.0
Algorithmic governance in artificial intelligence-driven health systems: A southern African perspective
The use of algorithmic systems in public health is expanding rapidly in southern Africa, particularly in areas such as disease prediction, resource allocation and personalised healthcare. While these technologies offer efficiencies, their outputs are shaped by the quality, representativeness and governance of the underlying data. Tools such as polygenic risk scores and pathogen genomics often underperform in black African populations owing to under‐representation in genomic datasets, limiting clinical accuracy and access to precision health benefits. In low‐ and middle‐income countries, these disparities are amplified by fragmented health data systems, limited digital infrastructure, and weak regulatory oversight. Such conditions undermine the ability to detect and correct algorithmic bias, increasing the risk that digital health tools perpetuate inequities affecting rural, low‐income and marginalised populations. In this context, algorithmic systems may unintentionally reinforce existing health disparities. This commentary draws on the concept of biopolitics to highlight how algorithmic tools classify and manage populations through data‐driven processes. It emphasises the need for greater transparency, inclusion and accountability in the development and deployment of these technologies. Aligning health technology assessment processes with equity‐driven metrics and locally governed standards is essential to ensure that algorithmic governance supports, rather than undermines, equitable public health outcomes in the region.
Algorithmic governance and decision-making
Artificial intelligence applications in public health
Data bias and under-representation in Southern Africa
Copyright (c) 2026 S Naidoo, R Naidoo https://creativecommons.org/licenses/by-nc/4.0
Cost analysis of the school-based human papillomavirus vaccination programme in Tshwane Health District, South Africa
Background. Cervical cancer is a significant public health concern globally. Persistent infection with high-risk human papillomavirus (HPV) types is the necessary cause of virtually all cervical cancers, although rare HPV-negative cervical cancer cases have been reported. HPV is one of the most common sexually transmitted infections worldwide and is responsible for approximately 90% of all cervical cancer cases globally. Objectives. To estimate the financial costs and cost per fully vaccinated girl (FVG) of the school-based HPV vaccination programme in Tshwane Health District, South Africa. Methods. We conducted a cross-sectional cost analysis of the 2019 vaccination campaign using the World Health Organization Cancer Prevention and Control Costing (C4P) tool. The data for the programme were obtained from the District Health Information System and financial records. Costs were categorised by component and converted to USD. Results. The programme reached 15 734 girls with two doses (71.3% uptake). The total financial cost was ZAR21 127 298 (USD1 458 704). Service delivery (71.8%) and vaccine procurement (27.1%) were the main cost drivers. The cost per FVG was ZAR1 343 (USD92.94). Conclusion. The Tshwane school-based HPV vaccination programme had a high financial cost per FVG compared with other low- and middle-income countries, largely owing to staffing and procurement costs. Optimising delivery strategies can improve cost-efficiency and sustainability.
Copyright (c) 2025 T Ledibane, N R Ledibane, M Matlala https://creativecommons.org/licenses/by-nc/4.0
Helicobacter pylori infection: Knowledge and attitudes of college students in South Darfur State, Sudan
Background. Helicobacter pylori infection is a significant global health issue, affecting ~4.4 billion individuals worldwide in 2015, ~60% of the world’s population at that time. Knowledge and attitudes regarding H. pylori among college students remain poorly understood. Objectives. To assess knowledge and attitudes of college students regarding H. pylori infection. Methods. A cross-sectional study of 323 participants from a college population was conducted from March to April 2023. Results. Of the 323 participants, (42.7%) were male and (57.3%) were female. The majority of the students (86.4%) lived in urban areas, as opposed to 12.1% in rural areas. Overall, the participants demonstrated good knowledge about H. pylori; 87.3% knew that it is a bacterium that causes peptic ulcers, and 57.0% were aware that it can cause cancer. Personal reading was the most common source of information (44.0%), followed by mass media (31.3%) and social media (24.8%). Most participants (87.9%) believed that H. pylori infection can be treated with medication (‘tablets’). Just over half (50.2%) had undergone testing for H. pylori. The diagnostic investigation that most participants would prefer was the stool antigen test (36.5%), followed by a blood test (26.9%), the urea breath test (9.0%) and endoscopy (6.5%). While most of the participants demonstrated a reasonable understanding of H. pylori infection, some knowledge gaps were identified. Conclusion. The study findings highlighted the importance of implementing targeted education programmes to address the knowledge gaps identified among college students.
H. pylori, knowledge, attitudes, College Student, cross-sectional, South Darfur
Copyright (c) 2026 S I Alamin, A H Altyb, S Z Izza, A H Ahmed, A A Adam, E M Ibrahim, T H Musa, R M Abdelrahman https://creativecommons.org/licenses/by-nc/4.0
Spatiotemporal analysis of visceral leishmaniasis in the state of Bahia, Brazil, 2007 - 2017: Socioeconomic and environmental aspects
Background. Visceral leishmaniasis (VL) is a neglected zoonosis caused by the parasite Leishmania infantum, present throughout the world. In Bahia, a state in the north-eastern region of Brazil, there is a high prevalence. Objectives. To evaluate the role of socioeconomic and environmental factors in the epidemiology of VL though spatiotemporal analysis. Methods. Epidemiological data for Bahia were extracted from the System for Notification of Diseases of the Ministry of Health (SINAN), data on prolonged droughts were obtained through the Civil Bureau of the Government of the State of Bahia, and socioeconomic indicators were obtained through the Socioeconomic Performance Index (IPESE) and DATASUS, the Brazilian public unified health system department responsible for providing health data. Relative risk for VL was calculated for age classes, clinical manifestations, comorbidities and deaths, while spatial analysis relied on kernel density analyses to determine spatial patterns. Correlations between socioeconomic indices and epidemiological markers were explored. Results. From 2007 to 2017, 3 847 new VL cases and 227 deaths were reported in Bahia. The mean incidence was 1.73 per 100 000 population. Cases and deaths were concentrated in the central-northern region of the state, a relatively poor area with a dry/semi-arid climate. Cases were more frequent in urban areas (54.1%), in males (60.7%) and in children aged <10 years (48.2%). Municipalities that declared a state of emergency due to prolonged drought (SECO dataset) and IPESE were positively correlated (p=0.0001 and p=0.013, respectively) with VL cases reported in all age groups. Deaths from VL were significantly correlated with the Gini index (p=0.043). Conclusion. Our results paint a picture of socioeconomic and climatic vulnerability as determinants of VL epidemiology. Addressing socioeconomic inequalities and enhancing models to predict prolonged drought are actions that should be included in the prevention and control of VL, given that vulnerable populations will be the most affected by the frequency and intensity of extreme climatic events.
Copyright (c) 2025 L B da Costa, R Lustosa, M Solcà, C G Zeppelini, E Silver Soares, E Martins Neto, C R Franke https://creativecommons.org/licenses/by-nc/4.0
Integrated person centered care for improved coordination
Determining the incidence of breast cancer in Mbekweni, Paarl, South Africa, and the lived experiences of the women involved: A mixed-methods study
Background. Breast cancer was the most common cancer diagnosed in South African (SA) females in the year 2022, accounting for 24.1% of all cancers diagnosed. There are cultural factors that are thought to affect the early diagnosis of breast cancer in black SA women. No information on the incidence of breast cancer or its determinants specific to the study setting could be found. Objectives. To determine the incidence of breast cancer in women aged 35 - 69 years living in the Mbekweni community in Paarl, SA, and to evaluate the lived experiences of the women involved. Methods. This was a prospective observational study, with a convergent parallel mixed-methods design. The quantitative data were collected by means of a self-completed questionnaire, and findings on clinical breast examination, imaging reports and referrals to higher levels of care. The qualitative data were collected through small focus group discussions which were recorded, transcribed, and analysed through inductive thematic analysis. Results. Of the sample population of 381 participants, a total of 55 (14.4%) were found to have suspicious clinical findings and required an imaging study. Upon receipt of the imaging reports, 4 (1.0%) required referral for biopsies or further management. At the time of writing, only 1 participant (0.3%) had been confirmed as having cancer, which was used to calculate an incidence of breast cancer of 6 cases per 1 000 person-years. Although only a single case was identified during the study period, there was some awareness of and insight into breast cancer in this community. There was also a perceived increase in the prevalence of breast cancer. However, it is a disease still stigmatised by a plethora of myths and cultural beliefs, which negatively influences women’s choice to seek help early. Conclusion. The incidence of breast cancer in women aged 35 - 69 years in Mbekweni was low in absolute terms, with only one confirmed case during the study period. Despite this, some insight and awareness surrounding breast cancer in the community was evident. There is a significant desire for more information in this community, which can provide healthcare workers with a valuable opportunity to educate and empower the members and positively influence the overall health of the community.
Copyright (c) 2025 C de Kock, G N Hudson https://creativecommons.org/licenses/by-nc/4.0
Copyright (c) 2024 https://creativecommons.org/licenses/by-nc/4.0
Factors influencing stroke outcomes and the experiences of healthcare workers managing stroke patients in a South African hospital: A protocol for a mixed‐methods study
Background. Stroke, also known as cerebrovascular accident, is the second leading cause of death and a significant contributor to disability on a global scale. Stroke presents an important healthcare challenge in South Africa (SA), standing as the second most common cause of death after HIV/AIDS. However, there is a lack of comprehensive epidemiological data and research on the experiences of healthcare professionals in managing stroke patients in low- and middle-income countries such as SA. Objectives. To describe the profiles of and factors affecting outcomes for stroke patients admitted to Steve Biko Academic Hospital, Pretoria, SA, and explore the experiences of healthcare professionals managing these patients. Methods. The study will employ a mixed-methods approach, combining quantitative and qualitative methods. It will describe factors influencing outcomes for stroke patients at the hospital, utilising quantitative data analysis. Additionally, it will capture healthcare workers’ experiences through qualitative insights into their challenges and successes. Data will be gathered via REDCap forms for quantitative measures and through semi-structured interviews for qualitative information. Analysis will include descriptive statistics, logistic regression for variable relationships, and thematic analysis for qualitative patterns. Conclusions. This research aims to improve understanding of stroke management and the impact of a stroke unit at a central hospital.
Stroke management, Stroke Epidemiology, Stroke Unit, Central Hospital, Clinical governance
Stroke management, Stroke Epidemiology, Stroke Unit, Central Hospital
Neurology, Internal Medicine, Public Health Medicine
Copyright (c) 2025 L Mpuku, M Kakaza, D Basu, T Phashe https://creativecommons.org/licenses/by-nc/4.0
47th World Hospital Congress, International Hospital Federation, Rio de Janeiro 09 - 12 September 2024
Copyright (c) 2025 M C Chisale-Mabotja, M J Mathabathe https://creativecommons.org/licenses/by-nc/4.0
Oxford University Government Outcomes Lab 2024 Social Outcomes Conference, 5 – 6 September 2024
Outcomes Based Finance. Government Outcomes Lab. South Africa
Oxford Government Outcomes Lab Conference
Copyright (c) 2025 L-A C Davids, P Rousseau, N Slingers https://creativecommons.org/licenses/by-nc/4.0
Determinants of TB data quality in completeness, accuracy, and timeliness for TB programme decision-making in Tshwane District : A protocol for a cross-sec tional analytical study
Background. The quality of health information is crucial for TB programme monitoring and decision -making. South Africa faces challenges in the quality of reported TB data as evidenced in discrepancies reported between different sources. This poses a need to systematically assess the quality of TB data from districts to understand factors that contribute to TB data quality for use in decision-making. Objective. To determine factors influencing TB data quality for decision-making in the TB programme at a district level in South Africa. Methods. The study will follow a cross-sectional mixed methods design using an explanatory sequential method to achieve triangulation between the two research methods. The study setting is the Tshwane Health District (THD). Data will be collected from multiple TB data sources in selected clinics and multilevel TB programme personnel. Data collection will be conducted over six months from July 2024 to December 2024. A process flow framework will be used to document the current TB data recording systems in THD. Validated data quality assessment tools (DAQs) will be used for data auditing purposes. Furthermore, a self-administered questionnaire, and one-to-one semi-structured interviews will be used for qualitative data collection. Triangulation will be achieved by integrating both research method findings. The study will be initiated after obtaining approvals from relevant authorities. Conclusion. This research aims to gain insight and understanding of behavioural, systemic, organisational and technical factors that influence health data quality using TB programme data as a lens. This will enable quantifying of data quality elements and contribute to the body of research with regards to data quality in health.
Health data , data quality , Tuberculosis , programme decision-making
Data completeness , transparency , data reporting , timeliness
District health information system, Electronic database, source documents ,Health district ,Public health facility
Health data , data quality , Tuberculosis , programme decision-making, Data completeness , transparency , data reporting , timeliness, District health information system, Electronic database, source documents ,Health district ,Public health facility
Copyright (c) 2025 L Motimele, T Maimela, D Basu https://creativecommons.org/licenses/by-nc/4.0
A complex tapestry of urban health in South Africa
Copyright (c) 2024 D Basu https://creativecommons.org/licenses/by-nc/4.0
A cross-sectional study of the factors associated with the acceptance of oral HIV self-testing among medical students at Joseph Ki-Zerbo University in Ouagadougou in 2021
Background. New screening techniques are being used to diagnose HIV infection. Objective. To identify factors associated with the acceptance of oral HIV self-testing among medical students using the socio-ecological model. Method. We conducted a descriptive, analytical cross-sectional study among medical students from October 2020 to September 2021, with data collection carried out from 10 to 25 March 2021. Results. A total of 508 students participated, of whom 15.75% (n=80) had heard of oral HIV self-testing. The acceptance rate was 92.52% (n=470). Additionally, 76.52% (n=345) were willing to buy the self-test at a preferential price of less than Franc African Financial Community (FCFA) 1 000. Logistic regression analysis revealed a statistically significant relationship between acceptance of oral HIV self-testing and the importance placed on pre-test counselling (odds ratio (OR) 6.45, 95% CI 0.93 - 40.33; p=0.049). Conclusion. Oral HIV self-testing is widely accepted among medical students. However, pre-test counselling could further increase its use and help achieve the first 95 of the United Nations’ ambitious targets.
Copyright (c) 2025 A Kabore, O Gouwendmanégré Bérékia, J Johns, H Tognon, L Sènami Akoyi, T S Hema Tiemoko, N Meda https://creativecommons.org/licenses/by-nc/4.0
Annual district research conferences organised in the Gauteng Province
District research conference; Ekurhuleni; Gauteng; Johannesburg; Primary health care; Tshwane;
Copyright (c) 2024 L Mpuku, G Tesema https://creativecommons.org/licenses/by-nc/4.0
Effects of sociodemographic status, HIV disclosure, and self-reported adherence on treatment outcome among HIV/AIDS patients in south-western Nigeria
Background. HIV/AIDS is still a leading cause of death and a health threat to millions worldwide. Objectives. To assess the effects of sociodemographic status, HIV disclosure, and self-reported adherence on treatment outcome among patients living with HIV in south-western Nigeria. Methods. Four hundred and forty participants were recruited from six secondary health facilities offering antiretroviral therapy (ART) services in Osun State. A multistage sampling technique was used to select eligible participants. The level of significance was set at p<0.05. Results. Of the participants, less than half (42.0%) had good knowledge on HIV and ART services, while 73.0% had good treatment adherence, about one-quarter (20.7%) had been stigmatised or discriminated against, and 58.4% had disclosed their status to their sexual partner; 75.5% of the partners were supportive afterwards. Treatment outcome was favourable for 86.4% of the participants, and there was a significant relationship between marital status and viral load suppression (p=0.003) and between adherence and viral load suppression (p=0.001). Participants with good adherence were 2.6 times more likely to have a favourable treatment outcome than those with poor adherence. Conclusion. Adherence and marital status were found to be significantly associated with suppressed viral loads among people living with HIV.
Copyright (c) 2025 S O Olarewaju, C A Akinleye , S B Bola-Oyebamiji , O O Olusola, O K Israel, N E Anegbe , G M Israel, A O Fasanu, S C Adeyemo , E M Ogba, O O Kayode, T M Jacob, E O Ewenyi, N A Emeribe, E M Farinloye https://creativecommons.org/licenses/by-nc/4.0
Experiences of the use of the levonorgestrel intrauterine device for heavy menstrual bleeding: Device discontinuation rates and reasons for discontinuation among users at a regional hospital in the Western Cape - A seven-year review
Background. Medical management for heavy menstrual bleeding (HMB) in low- and middle-income countries is limited. The National Institute for Health and Care Excellence recommends the levonorgestrel intrauterine device (LNG-IUD) as first-line management for HMB. However, since 2019, South Africa’s (SA) Essential Medicines List (EML) guidelines have listed it as the last medical treatment option in the public health sector. An economic analysis conducted from a payer’s perspective found the LNG-IUD dominant at 5 years and more cost-effective at 1 year than other medical treatment options. However, it would no longer be dominant if the 5-year discontinuation rate exceeded 40%. Assumptions about continuation rates of the LNG-IUD for HMB were made, as no local SA data are available. Objectives. To assess the discontinuation rate of the LNG-IUD for HMB after 1 year and explore the reasons for discontinuation. Methods. This was a retrospective, folder-based study of patients who received the LNG-IUD for HMB at Tygerberg Hospital, Cape Town, SA between 2014 and 2020. Results. The hospital records of all women who received the LNG-IUD were reviewed. Incomplete records, duplications or prescriptions for contraception were excluded. Complete records were available for 100 patients, of whom 68 reported symptom improvement after 1 year and continued use. Thirty-two patients discontinued use, of whom eight experienced spontaneous expulsions and 24 requested removals. Reasons for discontinuation included ongoing symptoms (n=18), adverse effects (n=4) and the desire for fertility (n=2). Fourteen of the 24 patients who requested removal had a hysterectomy. The study showed a 68% continuation rate for the LNG-IUD, which is lower than in higher-income countries (82 - 88%). This rate is considered sufficient to endorse the affordability of LNG-IUD for HMB over 5 years. Conclusion. Offering LNG-IUD as the primary treatment may potentially improve the continuation rate. Further research is needed to assess the feasibility of recommending LNG-IUD as the first-line treatment in national policy, following patient discussion.
Copyright (c) 2024 A Swanepoel, T D Leong, T Esterhuizen, G S Gebhardt https://creativecommons.org/licenses/by-nc/4.0
Role of the patient and citizen in health technology assessment and decision-making in South Africa
HTA, patient involvement, decision-making, South Africa
Copyright (c) 2025 D Mueller, L Pretorius https://creativecommons.org/licenses/by-nc/4.0
Factors associated with advanced HIV in the Tshwane District drainage area: A protocol for a cross-sectional analytical study
Background. HIV continues to be a global pandemic. Despite significant achievements in reaching the global 95-95-95 targets, advanced HIV disease (AHD) continues to contribute to substantial morbidity and mortality, with 600 000 deaths worldwide in 2022 including 51 000 in South Africa (SA). The patient demographic has shifted from antiretroviral therapy (ART)-naïve individuals to those facing treatment interruptions or non-adherence. Objective. To explore the factors associated with AHD in patients within the Tshwane District drainage area, SA, where high treatment coverage has not fully curbed mortality rates. Method. This cross-sectional analytical study employs both quantitative and qualitative methods, utilising structured questionnaires and blood samples to assess ART levels, specifically dolutegravir. A minimum of 10 participants will undergo semi-structured interviews to explore their treatment experiences. Quantitative data will be analysed using descriptive and inferential statistics, while qualitative data will be examined through thematic analysis. Conclusion. This research aims to enhance the understanding of AHD-related factors to inform effective interventions and policies for HIV care.
Copyright (c) 2024 S Nair, K M Tshabalala , F Abdullah https://creativecommons.org/licenses/by-nc/4.0
Global surgery in Africa: Access to surgery, an opportunity to adopt a participatory community-based approach
participatory community-based approaches
Copyright (c) 2025 M Isiagi, S Maswime, K J Okop https://creativecommons.org/licenses/by-nc/4.0