BACKGROUND:Retention in HIV care remains challenging in sub-Saharan Africa. We evaluated whether training lay counsellors in Motivational Interviewing (MI) could improve outcomes among newly diagnosed people living with HIV (PLHIV) in South Africa. METHODS:We conducted a cluster-randomized pilot trial in eight Johannesburg primary healthcare clinics, randomized 1:1 to Thusa-Thuso intervention (7-day MI training plus 12-month mentorship) or standard-of-care (SOC). Adults PLHIV (≥18 years) were enrolled and followed for 12 months. The primary outcome was 12-month retention. The secondary outcome was HIV viral suppression (VL <50 copies/mL). We assessed dose-response associations between counsellor MI skills and outcomes. RESULTS:Between March 2020 and August 2021, 548 PLHIV were enrolled (n = 291 intervention; n = 257 SOC). The intervention significantly increased 12-month viral suppression (39.86% vs 28.40%; risk differences (RD): 11.12%; P = .007). Improvements occurred for ART initiation (88.3% vs 74.7%; RD: P = .085) and 12-month retention (51.9% vs 40.5%; P = .067). Patient retention increased with counsellor proficiency in cultivating change talk (RR: 1.47; P = .016), showing empathy (RR: 1.30; P = .020) and partnership (RR: 1.37; P = .010). CONCLUSION:MI training and mentorship for lay counsellors improved 12-month viral suppression among newly diagnosed PLHIV. Training existing cadres in MI skills is a high-leverage strategy to achieve UNAIDS 95-95-95 targets.
Background: South Africa faces overlapping epidemics of HIV and sexually transmitted infections (STIs), particularly among men who have sex with men (MSM). Data on asymptomatic Chlamydia trachomatis and Neisseria gonorrhoeae infections in MSM living with HIV are limited. Objectives: To determine the prevalence and incidence of asymptomatic C. trachomatis and N. gonorrhoeae infections among MSM living with HIV. Method: We conducted a pilot randomised controlled trial of the HIV coping and disclosure management intervention among 88 MSM living with HIV in Buffalo City, South Africa. Sexually transmitted infection screening for C. trachomatis and N. gonorrhoeae was performed at baseline and at a 17-week follow-up using nucleic acid amplification testing of urine and rectal swabs. Univariable logistic regression models were used to examine the relationship between conceptually important individual-level variables and any STI at baseline and week 17 of follow-up. Results: Mean age was 30 years in the intervention arm and 33 years in the control arm. At enrolment, most participants had an undetectable HIV viral load (79.1% intervention vs 80.0% control). Syphilis positivity was higher in the intervention arm (9.3% vs 2.3%). Baseline prevalence of STIs was high, including urethral and rectal C. trachomatis and N. gonorrhoeae infections. At week 17, STI prevalence was similar between arms (27.9% intervention vs 28.9% control). Univariable analyses did not identify any factors associated with STI at follow-up in either group. Conclusion: Asymptomatic STIs are highly prevalent and incident among MSM living with HIV in South Africa. Findings highlight the need to strengthen STI prevention, treatment and care services, and to innovative interventions.
People who inject drugs (PWID) and people who use drugs (PWUD) bear a disproportionate burden of hepatitis C virus (HCV) infection globally. In South Africa, HCV testing and treatment remain limited outside externally funded projects. This study investigated the implementation feasibility of assisted HCV self-testing (HCVST) among PWID and PWUD in Johannesburg. Between 12th May 2023 and 28th March 2024, participants were recruited to an implementation study across mobile harm reduction sites and a central clinic. Participants performed self-tests using either oral-fluid or blood-based HCV antibody rapid tests. Reactive results were followed by on-site venous sampling for confirmatory RNA testing and referral for direct-acting antiviral (DAA) therapy at a centralized facility. We describe HCV case-detection, care cascade progression, and behavioral risk factors associated with HCV reactivity using logistic regression. Of 1,566 participants tested, 998 (63.7%) were HCV reactive. The median age was 31 years (IQR 28–35); 82.2% were male and 77.1% identified as PWID. Ever injecting drugs (OR 35.6, 95% CI 23.6–56.0), frequent injecting (≥ daily: OR 36.7, 95% CI 25.1–55.3), and recent needle sharing (OR 7.3, 95% CI 5.8–9.3) were the strongest predictors of HCV reactivity. Histories of incarceration were also independently associated with HCV reactivity (OR 3.2, 95% CI 2.6–4.0). Despite high self-testing acceptability, progression through the care cascade was limited: among 854 RNA-confirmed infections, only 147 (17.2%) were prioritized for treatment, with three participants achieiving sustained virologic response. Thematic analysis identified fear of needles, poor venous access, and structural barriers, notably centralized treatment delivery, as key impediments to linkage. This study showed a high burden of HCV among PWID and PWUD in Johannesburg and demonstrates that assisted HCVST is acceptable. Centralized treatment models severely constrained linkage to care. Simplified delivery of treatment is critical in transforming diagnosis into cure. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial South African National Clinical Trial Registry unique identification number for the registry is DOH-27-122022-4828 ### Funding Statement This work was supported by Unitaid grant (2017-16-PSI-STAR to KH). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethical approval for the study was obtained from the University of the Witwatersrand Human Research Ethics Committee (220306), South African Health Products Regulatory Authority (MD20220801), South African National Clinical Trial Registry unique identification number for the registry is DOH-27-122022-4828, and World Health Organization Ethics Review Committee (0003847). All participants provided written informed consent prior to participation. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All relevant data are within the paper and its Supporting Information files.
Brucellosis is a significant issue in the Borena Zone of Ethiopia, causing economic losses due to decreased milk production, abortions, infertility, and weak offspring. However, it is underreported and adequately addressed in the region. A cross-sectional study was conducted in the Gomole and Dhas districts of the Borena Zone in Ethiopia between November 2022 and June 2023 to estimate the seroprevalence of brucellosis in livestock. The study included cattle, camels, sheep, and goats, with random sampling at the individual and herd levels. A total of 490 cattle, 160 camels, and 330 each of sheep and goats were tested for seroprevalence. Random sampling was done on farms within the peasant association to test livestock at the individual and herd levels. Blood samples were collected from 490 cattle, 160 camels, and 330 each from sheep and goats. Samples were screened with the rose Bengal test (RBT) confirmed with the indirect enzyme-linked immunosorbent assay (iELISA). Polymerase chain reaction (PCR) detected Brucella species in blood clot samples collected from seropositive animals. The highest prevalence was observed in goats, with individual and herd-level rates of 10.0 % and 56.7 %, respectively. In contact, cattle had the lowest prevalence, 1.4 % at the individual level and 23.0 % at the herd level. Both B. abortus and B. melitensis were detected in cattle, sheep, and camels, while B. melitensis was the most common species found in goats. Statistically significant differences in brucellosis prevalence were observed among species, with the highest rates in the Gomole district compared to Dhas. Female animals had a higher prevalence than males, especially those with a history of abortion. Logistic regression showed that district and host species were associated with Brucella infection, with Gomole herds at higher risk. Brucella melitensis infections were common in sheep, camels, and goats, while B. abortus infections were mainly in cattle, with mixed infections in all species except sheep. Brucella melitensis infections were common in sheep, camels, and goats in the Oromia pastoral community, while B. abortus infections were mostly seen in cattle, with mixed infections in all species except sheep.
