Page 11 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 4 of 6 Editorial

impact of interventions on the prevention of HIV in that teenagers. Testing at birth (PCR) was conducted in 87.6% of
country. The aim of the substudy was to identify and the HIV-exposed infants of whom four (1.1%) were positive.
characterise the risk-taking sexual activities that promote While birth PCR testing levels are commendable, only n = 157
viral transmission. The findings of the substudy are not (36.7%) of exposed infants had the recommended 10-week
surprising: self-reported risk-taking sexual behaviour of follow-up HIV-PCR test. Almost all exposed infants (n = 427,
adolescents and young adults differs between males and 99.8%) were given nevirapine prophylaxis. Did any of the
females. Subjects were aged 16–24 years. Of the 3380 study infected children start on ART? ‘No records were kept’. While
participants, n = 2311 reported being sexually active viz. prevention of mother-to-child transmission (PMTCT) has
women (65%) and men (35%). Enrolment took place from been a great success, gaps in care still exist. A third of the
October 2013 to November 2015. Univariate and multivariate mothers in 2016 were HIV positive…!? Ouch!!
data underline the importance of the following markers
of risk among women: inconsistent condom use, July 2019
intergenerational sex (with male partners > 10 years older) 14. Solomons DJ, Van der Merwe A, Esterhuizen TM,
and transactional sex among the poor. On the other hand, Crowley T. Factors influencing the confidence and
women were less likely than men to report being sexually knowledge of nurses prescribing antiretroviral treatment
active before 15 years, to use alcohol at or during intercourse in a rural and urban district in the Western Cape province.
and to report ≥ 2 (multiple) sexual partners in the preceding South Afr J HIV Med. 2019;20(1):a923. https://doi.
12 months. Men living close to urban areas and those with org/10.4102/sajhivmed.v20i1.923
internet access were at greater risk of being HIV-positive.
This paper is a must-read for health workers and Editor’s comment: NIMART stands for nurse-initiated and
administrators across southern Africa. Success of HIV (nurse) managed antiretroviral treatment. This is a cross-
prevention has been elusive in this age group. Treatment as sectional survey conducted among 77 NIMART nurses
prevention will take us far. But papers such as this provide recruited from 29 healthcare centres in the Western Cape
tools that communities can use to facilitate change. province of SA. The study covered both urban and rural
nurses and aimed to identify factors influencing the nurses’
12. Mukumbang FC, Van Wyk B, Van Belle S, Marchal B. ‘At
this [adherence] club, we are a family now’: A realist knowledge base and managerial or clinical confidence.
theory-testing case study of the antiretroviral treatment Important limitations are noted by the authors: the cross-
sectional and retrospective design, the small cohort, the large
adherence club, South Africa. South Afr J HIV Med. numbers of nurses who despite being NIMART ‘authorised’,
2019;20(1):a922. https://doi.org/10.4102/sajhivmed. nonetheless refused to participate in the study viz. n = 18 (25%)
v20i1.922
rural nurses and n = 22 (33%) urban nurses. Potential biases,
for example the ‘self-completing’ of the questionnaires, may
Editor’s comment: ‘How successful are adherence clubs have led to further limitations. Nonetheless, many nurses
actually?’ This paper examines two adherence clubs (50%) indicated high levels of confidence with regard to the
associated with a provincial public health facility in the nursing aspects of HIV patient management and examination.
Western Cape (facility Y) and provides a theoretic explanation But importantly, only 14% felt themselves to be expert enough
(‘realist evaluation’) as to how and why clubs work. The in the day-to-day interaction with patients, and in particular,
authors remind us that ‘only 62.3% of all people living with with the switching and stopping of ART. Contact with a
HIV (PLHIV) in South Africa are virally suppressed’, (www. ‘clinical mentor or clinician’ was limited for almost half
hsrc.ac.za/uploads/pageContent/9234/FINALPresent (n = 36/77, 47%): once a week (n = 19), once a month (n = 14)
ationsfor17Julylaunch.pdf.) and that only 63.3% of infected and annually (n = 3). The replies of some are worrying: ‘no’ (n
South Africans are retained in the national South African HIV = 34, 44%), when asked ‘do you feel your workload is
healthcare programme (Fox et al. PLoS Med 2018;15:30–43) acceptable?’, and ‘no’ (n = 37, 48%), when asked ‘are you
Without a cure in sight, South Africa needs a long-term satisfied with your work conditions’. Not surprisingly, the
programme that delivers stronger numbers. Although much study found that training, personal feedback, mentoring and
of the paper is taken up with providing a coherent thesis, seeing or caring for lots of patients had positive results with
the discussion and case evaluation provide practical steps to respect to knowledge and confidence. The small print is what
assist with improving outcomes from adherence clubs. worries me. NIMART-trained nurses are a precious asset to
Figure 4 in the article is a useful summary of the thesis. South Africa’s HIV response. I am worried because of those
13. Bisschoff C, Coulon J, Isaacs Z, et al. HIV testing at birth. Are NIMART nurses who refused to participate and those who
we getting it right? South Afr J HIV Med. 2019;20(1):a951. did, yet expressed unhappiness with their situation. How
https://doi.org/10.4102/sajhivmed.v20i1.951 widespread are these attitudes and views?
15. Chateau AV, Dlova NC, Dawood H, Aldous C. Outcomes
Editor’s comment: This is a brief retrospective, descriptive, of Stevens–Johnson syndrome and toxic epidermal
file-audit of births to HIV-positive mothers at the Mangaung necrolysis in HIV-infected patients when using systemic
University Community Health Centre, Bloemfontein, South steroids and/or intravenous immunoglobulins in
Africa, during 2016. A third of all the mothers treated at the Pietermaritzburg, South Africa. South Afr J HIV Med.
clinic in 2016 tested HIV-positive. A total of 428 babies were 2019;20(1):a944. https://doi.org/10.4102/sajhivmed.
born to these mothers. Out of the infected mothers 7.3% were v20i1.944

http://www.sajhivmed.org.za 4 Open Access