South African Medical Journal
type: channel
description: The South African Medical Journal (SAMJ) - first published in 1884 - is a monthly, peer reviewed, general medical journal publishing leading research impacting clinical care in southern Africa.
publisher: South African Medical Association
language: en
publication name: South African Medical Journal
issn: 0256-9574
copyright: Licensing Information The SAMJ 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. Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository. Publishing Rights Authors grant the Publisher the exclusive right to publish, display, reproduce and/or distribute the Work in print and electronic format and in any medium known or hereafter developed, including for commercial use. The Author also agrees that the Publisher may retain in print or electronic format more than one copy of the Work for the purpose of preservation, security and back-up.
items: Strengthening system leadership for the District Health System
items: The 6th UCT Bongani Mayosi Memorial Lecture: Fostering evidence-based humanity in the academy and beyond: Lessons from the legacy of Prof. Bongani Mayosi
items: A turn for the worse: The impact of deteriorating healthcare spending in South Africa
items: A new perspective to aid in MMed research report completion: The effort-time trajectory model
items: Everything is Tuberculosis: The History and Persistence of Our Deadliest Infection
items: Narrowing the care and treatment gap through a human resources for mental health plan: Key considerations
items: Evaluation of healthcare resource utilisation and costs associated with anogenital warts in South Africa
items: Opportunities for health system strengthening to reduce preventable trauma deaths in the Western Cape Province, South Africa: Findings from an expert panel review
items: CPD
items: The Life Esidimeni tragedy: A decade later
items: Routine blood monitoring in acne vulgaris patients on isotretinoin: Is reassessment warranted? A retrospective cohort study from Tygerberg Hospital
items: Best interests above belief: Constitutional guidance for life-saving medical decisions involving children
items: Prevalence and socioeconomic determinants of post-acute sequelae of SARS-CoV-2 among individuals from a peri-urban township and an informal settlement in Johannesburg, South Africa
items: Opportunities to expand delivery of prehospital tranexamic acid to bleeding trauma patients – findings from a prospective multicentre trauma study in the Western Cape Province, South Africa
items: Prevalence of alcohol use, associated risk factors, and the impact on the HIV care cascade among adolescent girls and young women in South Africa: Findings from the HERStory Study

Strengthening system leadership for the District Health System
type: item
description: Those working within the South African (SA) District Health System (DHS) have various roles in addressing population health and wellbeing needs. These include motivating and co-ordinating local providers offering community, primary healthcare facility and district hospital services, including prevention and promotion services, and facilitating whole-of-government and whole-of-society collaboration with other government and social actors. These roles cannot be fulfilled by exercising traditional, command-and-control public sector managerial authority. Instead, distributed system leadership is required: a form of leadership practised by individuals and teams that enables the collective action needed to address complex health needs, and that is supported by wider organisational structures and processes. Based on a range of experience, this in-practice article presents the rationale for, and description of, system leadership within the DHS; appraises current approaches to leadership and management development in South Africa from this perspective; and outlines a system leadership development approach that offers promise for DHS and health system strengthening.
subject: DHS series
  topic: section
subject: Dsitrict Health System
  topic: keywords
subject: system leadership
  topic: keywords
subject: leadership and management
  topic: keywords
subject: leadership development
  topic: keywords
subject: leadership and mangement
  topic: subjects
subject: district health system
  topic: subjects
subject: leadership development
  topic: subjects
subject: system leadership
  topic: subjects
subject: public health
  topic: disciplines
subject: health policy and systems
  topic: disciplines
creator: L Gilson
creator: H Schneider
creator: B Engelbrecht
creator: M Shung-King
rights: Copyright (c) 2026 L Gilson, H Schneider, B Engelbrecht, M Shung-King https://creativecommons.org/licenses/by-nc/4.0
date: 2026-04-30
publication date: 2026-04-30
starting page: e3562
ending page: e3562
doi: 10.7196/SAMJ.2026.v116i4.3562

The 6th UCT Bongani Mayosi Memorial Lecture: Fostering evidence-based humanity in the academy and beyond: Lessons from the legacy of Prof. Bongani Mayosi
type: item
description: -
subject: Tribute
  topic: section
subject: health outcomes
  topic: keywords
subject: Health Sciences
  topic: keywords
subject: Health sciences
  topic: subjects
subject: Discipline of Health Sciences
  topic: disciplines
creator: L Thabane
rights: Copyright (c) 2026 L Thabane https://creativecommons.org/licenses/by-nc/4.0
date: 2026-04-30
publication date: 2026-04-30
starting page: e4844
ending page: e4844
doi: 10.7196/SAMJ.2026.v116i4.4844

A turn for the worse: The impact of deteriorating healthcare spending in South Africa
type: item
description: The November 2023/2024 national health budget cuts represent the largest reduction in public health expenditure in South Africa’s post-apartheid history. This article critically examines the implications of these budget cuts within the context of the country’s post-apartheid health system reforms and macroeconomic strategies. Specifically, it documents the historical evolution of fiscal policies and health expenditure across three distinct periods: the 2008 - 2013 period, which witnessed a counter-cyclical fiscal strategy that improved healthcare access and began addressing apartheid-era disparities; the years 2013 - 2023, marked by economic and political instability, culminating in a national debt crisis exacerbated by COVID-19, which eroded health system resilience under fiscal consolidation policies; and the post-November 2023/2024 period, which represents a distinct threat to two decades of progress in health equity and outcomes under further fiscal consolidation measures. The article discusses the impact of these austerity measures on healthcare workers and patient populations and the implementation of the National Health Insurance, while exploring the ethical and legal implications. It concludes by proposing recommendations for system-wide reforms to mitigate the negative effects of these budget cuts and prevent systemic collapse.
subject: In Practice
  topic: section
subject: Health budget
  topic: keywords
subject: Health Justice
  topic: keywords
subject: Health economics
  topic: keywords
subject: Health systems
  topic: keywords
subject: Health Economics
  topic: subjects
subject: Health Justice
  topic: subjects
subject: Health Budget
  topic: subjects
subject: Health systems
  topic: subjects
subject: Health Economics
  topic: disciplines
subject: Health Justice
  topic: disciplines
subject: Health budget
  topic: disciplines
subject: Health Systems
  topic: disciplines
creator: A Bhorat
creator: D Nel
creator: L Cairncross
creator: M Visser
rights: Copyright (c) 2026 A Bhorat, D Nel, L Cairncross, M Visser https://creativecommons.org/licenses/by-nc/4.0
date: 2026-04-30
publication date: 2026-04-30
starting page: e3068
ending page: e3068
doi: 10.7196/SAMJ.2026.v116i4.3068

A new perspective to aid in MMed research report completion: The effort-time trajectory model
type: item
description: Background. Since 2011, the Health Professions Council of South Africa has required all specialist trainees to complete a Master of Medicine (MMed) research report, a requirement intended to strengthen the production of relevant local research. However, evidence shows that this expectation substantially increases trainee workload, contributes to delays in specialist registration and may impede clinical skills development. SA studies report that registrars frequently lack the time and support needed to complete research tasks, with many exceeding the nominal training period. These challenges mirror international experiences where integrating research into busy clinical programmes remains difficult. Objective. To introduce and describe the effort-time trajectory model as an innovative conceptual framework to support MMed trainees in planning and completing their research reports. Methods. We describe the effort-time trajectory model, originally developed by Nel, which complements existing scheduling-based research support models by explicitly incorporating anticipated cognitive effort. Drawing on educational theory, particularly cognitive load theory, the model conceptualises research progression as a dynamic trajectory of both practical and cognitive effort over time. Results. The model highlights predictable peaks – such as protocol development, data analysis and final writing – and lulls, such as routine data collection. Mapping these fluctuations enables early identification of periods where trainees are most vulnerable to overload and where targeted supervisory or institutional support may have the greatest impact. Conclusion. The effort-time trajectory model provides a more holistic lens for supporting MMed research training by accounting for both temporal and cognitive demands. Its application may reduce last-minute workload surges, improve research completion timelines and support more sustainable integration of research within specialist training programmes.
subject: Perspectives/opinion articles
  topic: section
subject: Master of Medicine (MMed)
  topic: keywords
subject: MMed research
  topic: keywords
subject: Cognitive load theory
  topic: keywords
subject: MMed
  topic: subjects
subject: MMed research
  topic: subjects
subject: Cognitive Load Theory
  topic: subjects
subject: Medical Education
  topic: subjects
subject: Medical Education
  topic: disciplines
creator: G Nel
creator: T Ruder
creator: S Kauchali
rights: Copyright (c) 2026 G Nel, T Ruder, S Kauchali https://creativecommons.org/licenses/by-nc/4.0
date: 2026-04-30
publication date: 2026-04-30
starting page: e4493
ending page: e4493
doi: 10.7196/SAMJ.2026.v116i4.4493

Everything is Tuberculosis: The History and Persistence of Our Deadliest Infection
type: item
description: -
subject: Book Review
  topic: section
subject: history
  topic: keywords
subject: Tuberculosis
  topic: keywords
subject: Tuberculosis
  topic: subjects
subject: history
  topic: subjects
subject: Epidemiology
  topic: disciplines
subject: medical history
  topic: disciplines
creator: M Swart
rights: Copyright (c) 2026 M Swart https://creativecommons.org/licenses/by-nc/4.0
date: 2026-04-30
publication date: 2026-04-30
starting page: e4818
ending page: e4818
doi: 10.7196/SAMJ.2026.v116i4.4818

Narrowing the care and treatment gap through a human resources for mental health plan: Key considerations
type: item
description: -
subject: Editorials
  topic: section
subject: Mental Health; Human Resources
  topic: keywords
subject: Mental Health, Human Resources
  topic: subjects
subject: General medicine, Psychiatry, Psychology, Nursing
  topic: disciplines
creator: M Freeman
creator: G Wolvaardt
creator: G Maimela
rights: Copyright (c) 2026 M Freeman, G Wolvaardt, G Maimela https://creativecommons.org/licenses/by-nc/4.0
date: 2026-04-30
publication date: 2026-04-30
starting page: e4774
ending page: e4774
doi: 10.7196/SAMJ.2026.v116i4.4774

Evaluation of healthcare resource utilisation and costs associated with anogenital warts in South Africa
type: item
description: Background. Human papilloma virus (HPV), the most prevalent sexually transmitted infection worldwide, and in particular HPV 6 and 11, contribute to >90% of anogenital warts (AGW) cases, and high-risk HPV serotypes cause >95% of cervical cancers in South Africa (SA). The healthcare resource utilisation (HCRU) and costs related to AGW in SA remain poorly understood, in both the public and private sectors. Objective. To assess the HCRU patterns and associated treatment costs for AGW across the public and private sectors. Methods. A descriptive, questionnaire-based study was conducted, involving 50 subject matter experts (SMEs) from SA: 24 from the private sector and 26 from the public sector. The study explored resource use, treatment patterns and cost estimation based on SME responses. Results. Findings revealed that public-sector SMEs treated a larger volume of AGW patients per month (1 - 300) than private-sector SMEs (0 - 20). Most AGW patients were female, comprising 78% in the public sector and 72% in the private sector. The occurrence of AGW was higher in the public sector, ranging between 21.4% and 34.4%, while in the private sector, the occurrence ranged from 13.1% to 23.2%. The weighted cost per patient per episode was higher for females than males in both sectors. In the private sector, costs were ZAR22 482 for females and ZAR17 812 for males, while in the public sector, costs were ZAR19 220 for females and ZAR14 271 for males. The higher costs for females were driven by invasive diagnostic procedures, including vulvar colposcopy and biopsy, and a higher frequency of medical visits (2.0 - 4.4 visits in the public sector). Recurrence rates of AGW were reported at 37.6% in the private sector and 43.9% in the public sector. The total estimated treatment cost of AGW was notably higher in the public sector for both males (ZAR93.6 - ZAR138.5 billion) and females (ZAR135.2 - ZAR207.7 billion), compared with the private sector (males: ZAR11.0 - ZAR19.4 billion; femal…
subject: Research
  topic: section
subject: Anogenital warts, HPV, Anogenital diseases, Healthcare costs, Healthcare resource utilisation, South Africa
  topic: keywords
subject: Anogenital warts, HPV, health care resource utilization
  topic: subjects
subject: gynaecology, urology, general medicine, dermatology, pathology
  topic: disciplines
creator: S Mutambirwa
creator: M H Botha
creator: B M Mulaudzi
creator: M S Mabenge
creator: T Gaqana
rights: Copyright (c) 2026 S Mutambirwa, M H Botha, B M Mulaudzi, M S Mabenge, T Gaqana https://creativecommons.org/licenses/by-nc/4.0
date: 2026-04-30
publication date: 2026-04-30
starting page: e2772
ending page: e2772
doi: 10.7196/SAMJ.2026.v116i4.2772

Opportunities for health system strengthening to reduce preventable trauma deaths in the Western Cape Province, South Africa: Findings from an expert panel review
type: item
description: Background. Injuries are a leading cause of death and disability worldwide, and disproportionately affect young persons (aged 15 - 49 years) residing in low- and middle-income countries. Panel reviews of trauma deaths are an effective way to identify areas for improvement within a health system. Objectives. To assess the preventability of trauma deaths that had contact with the health system, and the associated panellists’ recommendations for improvements. Methods. A comprehensive review of injury-related deaths identified by an epidemiological study was conducted in the Western Cape Province of South Africa in April 2022. Panellists identified contributing factors and opportunities for improvement for each case. Investigators assigned a thematic code to each opportunity for improvement, and codes were categorised and mapped into a matrix organised according to the applicable level of the health system and the descriptive category for improvement. Results. Twenty-three multidisciplinary expert panellists reviewed 90 injury deaths that occurred in 2021. The largest proportion of deaths was from firearms (30%), and 41 (45%) of the 90 cases were found to be preventable or potentially preventable. The median time from injury to death was 41.4 hours for rural injuries, compared with 12.9 hours for urban injuries. Conclusion. Key recommendations from the panel included training in basic trauma resuscitation, and increased access to patient monitoring, operating theatres, radiology and intensive care beds. Panellists further recommended implementation of injury primary prevention strategies in the community.
subject: Review
  topic: section
subject: Trauma
  topic: keywords
subject: inter-personal violence
  topic: keywords
subject: preventable trauma death review
  topic: keywords
subject: health system improvement
  topic: keywords
subject: injury
  topic: keywords
subject: injury death
  topic: keywords
subject: Trauma Surgery, Thoracotomy, Emergency Care, Injury
  topic: subjects
subject: Trauma
  topic: subjects
subject: Public Health
  topic: subjects
subject: health system
  topic: subjects
subject: Trauma, Public Health
  topic: disciplines
subject: Surgery, Trauma, Cardiothoracic surgery, Vascular Surgery
  topic: disciplines
subject: Emergency Medicine
  topic: disciplines
subject: health system development
  topic: disciplines
creator: J Dixon
creator: S de Vries
creator: S Bhaumik
creator: C Dymond
creator: M Ross
creator: J Finn
creator: H Geduld
creator: E Steyn
creator: H Lategan
creator: L Hodsdon
creator: J Verster
creator: S Mukonkole
creator: K Doubell
creator: N-K Mould-Millman
rights: Copyright (c) 2026 J Dixon, S de Vries, S Bhaumik, C Dymond, M Ross, J Finn, H Geduld, E Steyn, H Lategan, L Hodsdon, J Verster, S Mukonkole, K Doubell, N-K Mould-Millman https://creativecommons.org/licenses/by-nc/4.0
date: 2026-04-30
publication date: 2026-04-30
starting page: e3030
ending page: e3030
doi: 10.7196/SAMJ.2026.v116i4.3030

CPD
type: item
subject: CPD
  topic: section
subject: CPD
  topic: keywords
creator: A Dhai
rights: Copyright (c) 2026 A Dhai https://creativecommons.org/licenses/by-nc/4.0
date: 2026-04-30
publication date: 2026-04-30
doi: 10.7196/

The Life Esidimeni tragedy: A decade later
type: item
subject: From the editor
  topic: section
subject: Life Esidimeni
  topic: keywords
creator: A Dhai
rights: Copyright (c) 2026 A Dhai https://creativecommons.org/licenses/by-nc/4.0
date: 2026-04-30
publication date: 2026-04-30
starting page: e5217
ending page: e5217
doi: 10.7196/

Routine blood monitoring in acne vulgaris patients on isotretinoin: Is reassessment warranted? A retrospective cohort study from Tygerberg Hospital
type: item
description: Background. Oral isotretinoin is an indispensable treatment for patients with resistant and severe acne vulgaris, both in South Africa (SA) and globally. While routine laboratory monitoring is often deemed unnecessary for young, healthy patients, it remains unclear whether this applies in the SA context. Objectives. To assess the need for routine blood monitoring for acne vulgaris patients on isotretinoin treatment at Tygerberg Hospital, SA. Specifically, we wanted primarily to determine the prevalence of patients with acne vulgaris whose oral isotretinoin treatment was altered owing to blood result abnormalities, and secondarily, to determine the prevalence of adverse events and liver function and lipid profile abnormalities associated with isotretinoin. Methods. This was a retrospective cohort study of hospital records from patients with acne vulgaris treated with oral isotretinoin at the dermatology clinic at Tygerberg Hospital between 1 January 2020 and 31 December 2023. There were 89 eligible records extracted from the Tygerberg Hospital Enterprise Content Management system. Baseline and 6-week follow-up laboratory data, including liver function tests and lipid profile, were extracted retrospectively from the National Health Laboratory Service. Results. The sample comprised 89 patient hospital records, 62% male and 38% female. Of the total, 53% were aged between 12 and 20 years. Blood result abnormalities led to alterations in treatment regimens for 2/89 (2.2%) patients: one patient required treatment termination, while another continued on low-dose isotretinoin instead of the planned dose increase. Two patients (2.2%) developed increased aspartate aminotransferase levels and five (5.6%) developed new alanine aminotransferase increases above the upper limit of the normal range. Elevated triglyceride levels occurred in two patients (2.2%), and elevated cholesterol levels in nine (10.1%). Adverse events resulting in the premature termination of treatment with iso…
subject: Research
  topic: section
subject: Acne vulgaris, Isotretinoin use, laboratory monitoring, blood result abnormalities
  topic: keywords
subject: Acne vulgaris, Isotretinoin, laboratory monitoring, lipid profile, hepatic enzymes, cost-saving, resource-constrained, South Africa
  topic: subjects
subject: Dermatology
  topic: disciplines
creator: J du Toit
creator: N A Gray
creator: T M Esterhuizen
creator: W I Visser
rights: Copyright (c) 2026 J du Toit, N A Gray, T M Esterhuizen, W I Visser https://creativecommons.org/licenses/by-nc/4.0
date: 2026-04-30
publication date: 2026-04-30
starting page: e3588
ending page: e3588
doi: 10.7196/SAMJ.2026.v116i4.3588

Best interests above belief: Constitutional guidance for life-saving medical decisions involving children
type: item
description: -
subject: Editorials
  topic: section
subject: best interests of the child,
  topic: keywords
subject: life-saving medical decisions
  topic: keywords
subject: constitutional rights of the child
  topic: keywords
subject: Red Cross War Memorial Children’s Hospital v MD and Another
  topic: keywords
subject: best interests of the child
  topic: subjects
subject: life-saving medical treatment
  topic: subjects
subject: law
  topic: disciplines
creator: S Mahomed
rights: Copyright (c) 2026 S Mahomed https://creativecommons.org/licenses/by-nc/4.0
date: 2026-04-30
publication date: 2026-04-30
starting page: e5111
ending page: e5111
doi: 10.7196/SAMJ.2026.v116i4.5111

Prevalence and socioeconomic determinants of post-acute sequelae of SARS-CoV-2 among individuals from a peri-urban township and an informal settlement in Johannesburg, South Africa
type: item
description: Background. Individuals infected with SARS-CoV-2 who develop COVID-19 are susceptible to persistent symptoms and sequelae, referred to as post-acute sequelae of SARS-CoV-2 (PASC). The prevalence of PASC is estimated to range between 10% and 30%. However, there is a paucity of data from African countries. Objectives. To investigate the prevalence and sociodemographic determinants of PASC in a peri-urban township and an informal settlement in South Africa (SA) during the COVID-19 pandemic. Methods. A prospective cohort study was conducted among individuals residing in sampled households within the Soweto and Thembelihle Health and Demographic Surveillance System in Gauteng Province, SA. Between August 2021 and January 2022, all individuals from 214 sampled households were tested for SARS-CoV-2 and followed up for 6 months for symptoms. The prevalence of PASC, defined as persistence of symptoms through to at least 30 (PASC-30) and 90 (PASC-90) days, was evaluated, and determinants of PASC were identified using logistic regression models. Results. There were 268 individuals with documented COVID-19 illness identified, of whom 65.3% (n=175) were female. The median age was 24 years. The overall prevalence of PASC-30 was 23.9% (95% confidence interval (CI) 19.2 - 29.3), including 24.6% (95% CI 19.7 - 30.3) and 12.5% (95% CI 3.5 - 36.0) in individuals who were unvaccinated or had received a COVID-19 vaccine, respectively (p=0.283). The overall prevalence of PASC-90 was 2.2% (95% CI 1.0 - 4.8). Factors associated with PASC-30 included living in an informal (39.2%, 105/268) v. formal settlement (60.6%, 163/268) (adjusted odds ratio (aOR) 4.1, 95% CI 2.1 - 8.3), although participants living in larger households (aOR 0.8, 95% CI 0.7 - 0.9, p=0.011) were less likely to report PASC-30 than those from smaller households. Age, gender, marital status, level of education, employment status, vaccination status and the presence of comorbidities were not significantly associated with PA…
subject: Research
  topic: section
subject: COVID-19
  topic: category
subject: South Africa, Soweto, peri-urban, HDSS, long-COVID
  topic: keywords
subject: South Africa
  topic: subjects
subject: Soweto
  topic: subjects
subject: peri-urban
  topic: subjects
subject: Health and Demographic Surveillance System
  topic: subjects
subject: long-COVID
  topic: subjects
subject: Infectious Disease
  topic: disciplines
creator: T Machemedze
creator: P Mutevedzi
creator: A Izu
creator: N Myburgh
creator: C Verwey
creator: S Mahtab
creator: Z Dangor
creator: S Madhi
rights: Copyright (c) 2026 T Machemedze, P Mutevedzi, A Izu, N Myburgh, C Verwey, S Mahtab, Z Dangor, S Madhi https://creativecommons.org/licenses/by-nc/4.0
date: 2026-04-30
publication date: 2026-04-30
starting page: e3643
ending page: e3643
doi: 10.7196/SAMJ.2026.v116i4.3643

Opportunities to expand delivery of prehospital tranexamic acid to bleeding trauma patients – findings from a prospective multicentre trauma study in the Western Cape Province, South Africa
type: item
description: Background. Traumatic haemorrhage is a leading cause of preventable injury-related deaths. Tranexamic acid (TXA) has demonstrated a 38% all-cause mortality reduction when administered to severe haemorrhagic shock patients in South Africa (SA). Yet its prehospital utilisation in SA remains limited owing to prehospital provider qualification restrictions, despite the region’s high trauma burden. Among the 4% of prehospital providers licensed to administer TXA, prehospital eligibility and TXA administration is poorly reported. This utilisation gap suggests multifactorial barriers beyond the current scope of practice restrictions that impede effective implementation of this evidence-based intervention. Objective. To assess patterns of TXA administration and omission during prehospital emergency care in the Western Cape Province, SA. Methods. This is a secondary analysis from the EpiC prospective multicentre study. The current study examined 4 094 patients at risk of haemorrhage in the Western Cape from August 2021 to December 2024. First, we assessed patient and injury characteristics as well as prehospital and hospital treatments among three prehospital treatment groups: those who received TXA; those who received a lifesaving circulation intervention and no TXA; and those who received neither. Second, a subset of patients was selected for three clinical scenarios: patients with moderate to severe risk of shock; those with severe shock meeting TXA eligibility criteria; and those requiring hospital-based interventions for haemorrhage. Prehospital provider qualifications, clinical interventions and outcomes were assessed using descriptive statistics, and Sankey diagrams were used to visually depict the quantity and flow of prehospital trauma patients stratified by prehospital provider qualification. Results. Only 2.8% (n=116) of all haemorrhage-risk patients received prehospital TXA despite 82% (n=3 325) presenting within the 3-hour window for administration. Among eligib…
subject: Research
  topic: section
subject: Tranexamic Acid
  topic: keywords
subject: Wounds and Injury
  topic: keywords
subject: Haemorrhage
  topic: keywords
subject: Emergency Medical Services
  topic: keywords
subject: Tranexamic acid
  topic: subjects
subject: Wounds and Injury
  topic: subjects
subject: Haemorrhage
  topic: subjects
subject: Emergency Medical Services
  topic: subjects
subject: Emergency Medicine
  topic: disciplines
subject: Emergency Medical Services
  topic: disciplines
subject: trauma
  topic: disciplines
subject: Public Health
  topic: disciplines
creator: N Abdullah
creator: J Young
creator: W Stassen
creator: C Wylie
creator: H J Lategan
creator: G Oosthuizen
creator: S de Vries
creator: J Verster
creator: EpiC Study Site Collaborators
creator: J M Dixon
creator: N-K Mould-Millman
rights: Copyright (c) 2026 N Abdullah, J Young, W Stassen, C Wylie, H J Lategan, G Oosthuizen, S de Vries, J Verster, EpiC Study Site Collaborators, J M Dixon, N-K Mould-Millman https://creativecommons.org/licenses/by-nc/4.0
date: 2026-04-30
publication date: 2026-04-30
starting page: e3787
ending page: e3787
doi: 10.7196/SAMJ.2026.v116i4.3787

Prevalence of alcohol use, associated risk factors, and the impact on the HIV care cascade among adolescent girls and young women in South Africa: Findings from the HERStory Study
type: item
description: Background. High rates of hazardous and binge drinking patterns have been identified among adolescent girls and young women (AGYW) in South Africa. AGYW also bear the highest burden of HIV/AIDS in the country, placing them at increased risk of negative outcomes for both HIV and alcohol. Objectives. To estimate the prevalence of alcohol use and describe the patterns of use for AGYW enrolled in the HERStory Study. Secondary aims included identifying covariates of alcohol consumption and examining the impact of alcohol use patterns on the HIV care continuum. Methods. We included all 4 377 AGYW (aged 15 - 24 years) enrolled in the HERStory baseline survey from six high HIV-risk districts. Alcohol consumption was assessed using the abbreviated Alcohol Use Disorders Identification Test, the AUDIT-C screening tool, with a score of ≥2 indicating hazardous drinking, while binge drinking was defined as consuming ≥6 drinks on one occasion at least monthly. Results. Among participants, the median (interquartile range) age was 19 (17 - 21) years; 57.2% attended school, 82% were of low socioeconomic status and 66.3% self-reported as HIV negative. The prevalence of alcohol use was 32.2% and was highest among women aged 20 - 24 years (36.1%) and among those living in the Cape Town and Tshwane districts (52.8% and 51.6%, respectively). Of the 1 394 participants who reported ever drinking, 50.6% reported hazardous drinking and 22.7% binge drinking. Hazardous drinking was associated with residence in Cape Town district (odds ratio (OR) 2.25) and absence from school (OR 1.42) in univariate analyses. The odds of binge drinking were 2 - 7 times greater in all districts compared with King Cetshwayo in univariate analyses, and remained significant in the multivariate analysis. No association was found between hazardous or binge drinking and HIV care outcomes. Conclusion. The prevalence of alcohol use was elevated in the population of young women aged 20 - 24 years. Hazardous and binge drin…
subject: Research
  topic: section
subject: Adolescents
  topic: keywords
subject: alcohol use
  topic: keywords
subject: HIV
  topic: keywords
subject: South Africa
  topic: keywords
subject: Alcohol, Adolescents, HIV, South Africa
  topic: subjects
subject: Public Health
  topic: disciplines
subject: Epidemiology
  topic: disciplines
creator: M R Tlali
creator: M A Davies
creator: C Lombard
creator: C Mathews
creator: C D Parry
rights: Copyright (c) 2026 M R Tlali, M A Davies, C Lombard, C Mathews, C D Parry https://creativecommons.org/licenses/by-nc/4.0
date: 2026-04-30
publication date: 2026-04-30
starting page: e3164
ending page: e3164
doi: 10.7196/SAMJ.2026.v116i4.3164