The Human Sciences Research Council (HSRC) of South Africa is Africa's largest dedicated social science and humanities research agency and policy think tank. It primarily conducts large-scale, policy-relevant, social-scientific projects for public-sector users, for non governmental organisations and international development agencies in support of development nationally, in the Southern African Development Community (SADC) and in Africa. The HSRC also seeks to contribute to the research and development strategy of the HSRC's parent Department of Science and Technology, especially through its mission to focus on the contribution of science and technology to addressing poverty. The HSRC originates in the National Bureau of Education and Social Research (founded in 1929). In recent years the HSRC has undergone major restructuring, aligning its research activities and structures to South Africa's national development priorities: notably poverty reduction through economic development, skills enhancement, job creation, the elimination of discrimination and inequalities, and effective service delivery.
BACKGROUND:Globally, approximately half of new HIV acquisitions occur among African adults. This analysis examines which cisgender men are at highest risk of acquiring HIV-1 and in greatest need of HIV pre-exposure prophylaxis (PrEP). SETTING:National population-based surveys from Eswatini, Ivory Coast, Kenya, Lesotho, Malawi, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe. METHODS:The 13 surveys were pooled and sampling weights were applied to represent all susceptible men aged 15-59 years old. HIV-1 incidence was calculated based on a recent HIV-1 testing algorithm. A least absolute shrinkage and selection operator (Lasso) regression model was fit with 28 variables to predict recent HIV-1. Models were trained and internally cross-validated to estimate area under the receiver-operating characteristic curve (AUC). Along the receiver-operating characteristic curve, at sensitivity levels from 10% to 90%, performance tradeoffs were evaluated. RESULTS:Of 167,121 participants, 112 had recent HIV-1, representing 256,000 new annual infections among 122 million men. Only 2 variables were retained-reporting a male sexual partner and living in a subnational area where a high proportion of adults have detectable HIV-1 viremia. Overall AUC was 0.80 (95% Confidence Interval: 0.71 to 0.89); cross-validated AUC was 0.76 (95% CI: 0.64 to 0.87). At 10% sensitivity, 25,000 cases could be averted if 357,000 men adhered to PrEP (Number Needed to Treat = 14). At 90% sensitivity, 229,000 cases could be averted if 50 million men adhered to PrEP (Number Needed to Treat = 219). CONCLUSIONS:This predictive, parsimonious, generalizable risk assessment tool could help policymakers weigh tradeoffs between PrEP reach and efficiency.
Background In January 2025, funding through the U.S. President's Emergency Plan for AIDS Relief was disrupted. While modeling studies have projected the consequences of these financing interruptions, models are not based on population-representative, real-world impacts on service delivery and clinic operations. We aimed to quantify disruptions to facility-level services, operations, and staffing resulting from foreign aid instability using province-representative facility audit data from South Africa. Methods We used a probability-proportional-to-facility-size sampling approach to select public facilities providing HIV care in KwaZulu-Natal, South Africa for inclusion in Uhambo Lwami, a multisite, observational cohort study. Structured, cross-sectional surveys were conducted with clinic Operational Managers from January to July 2025 to document interruptions to clinic services, operations, and staffing. Perceived impacts of these interruptions were also captured. Province-representative estimates of the prevalence of facilities impacted and patients served by impacted facilities were quantified using inverse probability weighting. Findings Thirty-six of 519 clinics (6.9%) were sampled. A total of 179,586 unique people with HIV were seen across sampled clinics (11.1%), representing 1,622,247 people with HIV after weighting. Fifteen sampled clinics (41.7%) serving 88,620 people with HIV, representing 200 (38.5%) clinics serving 828,413 (51.1%) people with HIV in the province, reported service, operations or staffing interruptions due to funding cuts. The most common operational interruption was in data entry/filing, affecting 13.4% of clinics (N = 70). Patient tracing, HIV testing, and treatment services were interrupted in 9.9% of clinics (N = 52) serving 429,934 people with HIV (26.5%) in the province. Nearly 30% of clinics (N = 152) in the province experienced staffing disruptions; layoffs of data capturers (N = 142; 27.3%) and community health workers (N = 121; 23.4%) were most common. Increases in clinic wait times were reported in 11.0% (N = 57) of facilities. Interpretation Instability in global HIV funding may have impacts beyond anti-retroviral supply, undermining a range of functions, including the labor force and patient support mechanisms, that play an essential role in treatment success. The public health response to funding disruptions should aim to uphold the breadth of services that have supported the success of the HIV response to date. Funding Gates Foundation.
BACKGROUND:Klebsiella pneumoniae causes ~20% of sepsis in neonates, with ~40% crude mortality. A vaccine administered to pregnant women, protecting against ≥70% of K. pneumoniae infections, could avert ~400,000 cases and ~80,000 deaths annually, mostly in Africa and South Asia. Vaccine formulations targeting the capsular polysaccharide (K) or lipopolysaccharide (O) antigens are in development. Global K. pneumoniae populations display extensive K and O diversity, necessitating a polyvalent vaccine targeted to the serotypes associated with neonatal disease in relevant geographical regions. We investigated the prevalence of K and O types associated with neonatal sepsis in Africa and South Asia to inform maternal vaccine design. METHODS AND FINDINGS:We analysed 1,930 K. pneumoniae neonate blood isolates from 13 surveillance studies across 35 sites in 13 countries. We used pathogen whole-genome sequencing to predict K and O serotypes and adjust for local transmission clusters, and Bayesian hierarchical meta-analysis to estimate K and O prevalence overall and per region, treating site as a random effect. Eighty-seven K loci were identified. KL2, KL102, KL25, KL15, and KL62 accounted for 49% of isolates. We estimate that 20 K loci, combining the eight most prevalent per region, could cover 72.9% of all infections (95% credible interval: [69.4%, 76.5%]) and ≥70% in each of Eastern, Western, and Southern Africa and South Asia. Preliminary findings from three sites suggested sufficient temporal stability of K loci to maintain 20-valent K vaccine coverage over 5-10 years, but more longitudinal data are needed to support this prediction. O types were far less diverse (n = 14 types). We estimate the top-5 (O1⍺β,2⍺, O1⍺β,2β, O2⍺, O2β, and O4) would cover 86.2% [82.6, 89.9%] of total infections (76%-92% per region), while the top-10 would cover ~99% of infections in all four regions. The main limitations of our study are the reliance on genome sequences to predict K and O serotypes (as serological typing is not available) and a lack of longitudinal data to explore stability of antigen prevalence over time. CONCLUSIONS:Neonatal sepsis is associated with diverse K and O types, with substantial geographic and temporal variation even after adjusting for localised transmission clusters. Despite this, a single 20-valent K vaccine could theoretically cover ≥70% of infections in all target regions. Locally-targeted vaccines could achieve higher coverage with lower valency, but are less feasible. In principle, very high coverage could be achieved with lower valency O-based vaccines, however, the protective efficacy against disease of antibodies targeting the O antigen remains uncertain. Further research is needed on cross-reactivity, antigen exposure, and stability of antigens over time, to better inform vaccine development.
The objective of this review was the assessment of the effect of flavonoid sources on nutrient intake and digestibility, rumen fermentation, growth performance, milk production and endoparasites in ruminant production. The increasing human population is creating a greater demand for animal products to meet the protein needs. However, an increase in animal production is likely to force the overuse of synthetic antibiotics, which may intensify drug-resistant pathogens. As a solution, there is a need to discover natural feed additives to improve environmental harmlessness, health and performance in ruminant production. This is because ruminants produce methane and suffer from infections such as gastrointestinal nematodes and mastitis that limit animal performance. Hence, there is a need to identify feed additives that decrease this gas without limiting nutrient utilization and animal performance. Flavonoid dietary inclusion is a potential solution to this challenge in ruminant production and has received research attention. However, there is a preliminary understanding of the effect of inclusion on effectiveness in decreasing methane production and pathogens, improving rumen fermentation, milk production and growth performance in ruminants. Therefore, there is a need for the identification of the effect of flavonoid inclusion on the abovementioned parameters for the detection of research limitations requiring assessment for the identification of a single flavonoid inclusion with a holistic effect on the production parameters of ruminants.
BACKGROUND:Active tuberculosis case-finding in communities is crucial for early disease detection and disruption of transmission; however, it is complex and costly. A thorough analysis of tuberculosis screening strategies is essential, particularly because the health systems affected often have limited resources. We aimed to compare two community screening approaches in terms of tuberculosis case yield and cost. METHODS:This pragmatic community trial, with a paired screen-positive design (ie, within-person comparison), was conducted in the Butha-Buthe District in Lesotho and the uMgungundlovu District in South Africa. All household members aged at least 18 years were eligible to participate, except those who were seriously ill, had a condition that prevented their safe and full participation, were receiving tuberculosis treatment, or were pregnant (Lesotho only). We compared two screening approaches: the use of computer-aided detection (CAD) software on digital chest x-rays alone (the CAD4TBv7 approach) and the use of CAD followed by a C-reactive protein (CRP) test if the CAD score was in a particular range (the CAD4TBv7-CRP approach). A confirmatory Xpert MTB/RIF Ultra test was conducted when required by the algorithm of one or both approaches. Coprimary outcomes were to establish whether the CAD4TBv7-CRP approach was non-inferior to the CAD4TBv7 approach (non-inferiority margin -10%) and to conduct a comparative cost analysis between the two approaches. FINDINGS:Among 20 023 enrolled participants, the median age was 42 years (IQR 29-60); 12 387 (61·9%) participants were female, 7625 (38·1%) were male, and 11 (0·1%) were intersex. 4534 (22·6%) of 20 023 participants were living with HIV, 1547 (7·7%) had a history of tuberculosis, and 1545 (7·7%) reported at least one of the four main symptoms of tuberculosis. The primary outcome set, defined as participants who were identified as having tuberculosis according to at least one of the two approaches and had complete data for both approaches, comprised 73 participants: the CAD4TBv7 approach identified 69 (94·5%) of these cases of tuberculosis and the CAD4TBv7-CRP approach identified 60 (82·2%) cases. The difference of -12·3% (95% CI -23·0 to -1·6) indicates that the non-inferiority criterion was not met. The cost per detected case of tuberculosis was US$5454 (95% uncertainty interval 4294-6777) for the CAD4TBv7 approach and $7486 (5948-9246) for the CAD4TBv7-CRP approach, making the CAD4TBv7-CRP approach 37·3% more expensive. INTERPRETATION:In active tuberculosis case-finding in our community setting, the combination of CAD followed by CRP testing offered no advantage over CAD alone owing to its inferior case yield and higher cost. CAD alone, however, has the potential to be an effective and economically viable tuberculosis screening strategy in areas with high disease burden. FUNDING:The European and Developing Countries Clinical Trials Partnership.
