Browsing by Author "Lombard, Carl J"

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    Open Access
    An approach for evaluating early and long term mother-to-child transmission of HIV (MTCT) in low and middle income countries: a South African experience
    (2019-09-16) Jackson, Debra J; Dinh, Thu-Ha; Lombard, Carl J; Sherman, Gayle G; Goga, Ameena E
    Abstract Background Eliminating mother-to-child transmission of HIV is a global public health target. Robust, feasible methodologies to measure population level impact of programmes to prevent mother-to-child transmission of HIV (PMTCT) are needed in high HIV prevalence settings. We present a summary of the protocol of the South African PMTCT Evaluation (SAPMTCTE) with its revision over three repeated rounds of the survey, 2010–2014. Methods Three cross sectional surveys (2010, 2011–2012 and 2012–2013) were conducted in 580 primary health care immunisation service points randomly selected after stratified multistage probability proportional to size sampling. All infants aged 4–8 weeks receiving their six-week immunisation at a sampled facility on the day of the visit were eligible to participate. Trained research nurses conducted interviews and took infant dried blood spot (iDBS) samples for HIV enzyme immunoassay (EIA) and total nucleic acid polymerase chain reaction (PCR) testing. Interviews were conducted using mobile phones and iDBS were sent to the National Health Laboratory for testing. All findings were adjusted for study design, non-response, and weighted for number of South African live-birth in each study round. In 2012 a national closed cohort of these 4 to 8-week old infants testing EIA positive (HIV Exposed Infants) from the 2012–2013 cross-sectional survey was established to estimate longer-term PMTCT impact to 18 months. Follow-up analyses were to estimate weighted cumulative MTCT until 18 months, postnatal MTCT from 6 weeks until 18 months and a combined outcome of MTCT-or-death, using a competing risks model, with death as a competing risk. HIV-free survival was defined as a child surviving and HIV-negative up to 18 months or last visit seen. A weighted cumulative incidence analysis was conducted, adjusting for survey design effects. Discussion In the absence of robust high-quality routine medical recording systems, in the context of a generalised HIV epidemic, national surveys can be used to monitor PMTCT effectiveness; however, monitoring long-term outcomes nationally is difficult due to poor retention in care.
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    Injury-related behaviour among South African high-school students at six sites
    (2006) Flisher, Alan J; Ward, Catherine L; Liang, Holan; Onya, Handsome; Mlisa, Nomfundo; Terblanche, Susan; Bhama, Susan; Parry, Charles D H; Lombard, Carl J
    Objectives. To document and compare prevalence rates of adolescent injury-related risk behaviours at six sites in South Africa. Design. The identical self-administered instrument was used at all sites. Prevalence rates (with 95% confidence intervals) were calculated taking the multistage cluster sampling strategy into account. Setting and subjects. In Cape Town, Durban, Port Elizabeth and Mankweng participants were drawn from either grades 8 or 9, and grade 11, while in Queenstown and Umtata they were drawn from grade 11 only. We selected 39 schools in Cape Town and Durban, 33 in Port Elizabeth and 20 in each of the rural areas. Outcome measures. Road-related risk behaviour, violence, and suicide attempts. Results. Across the sites there were high rates of risk behaviour in all domains. For example, in the 12 months preceding the survey an estimated 52.8% of grade 11 males in Cape Town had travelled in the front seat of a motor vehicle without a seatbelt, 33.0% of grade 8 males in Mankweng had bullied others, while 44.5% of the same group had been bullied, and 18.6% of females in Port Elizabeth had attempted suicide. Rates were lower in rural areas for behaviour involving motor vehicles, but there were no consistent urban-rural findings for violence-related behaviour. Females were at higher risk of suicidal behaviour and males were at higher risk of other injury-related behaviour. Conclusions. There is a need for effective interventions to reduce the extent of injury-related risk behaviour in adolescents in urban and rural settings.
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    A prospective study of methamphetamine use as a predictor of high school non-attendance in Cape Town, South Africa
    (BioMed Central Ltd, 2010) Plüddemann, Andreas; Flisher, Alan J; McKetin, Rebecca; Parry, Charles D; Lombard, Carl J
    BACKGROUND: This prospective study investigated the association between life-long methamphetamine and other drug use and high school non-attendance, in a sample of high school students in Cape Town, South Africa. METHODS: A random sample of 1535 high school students completed a baseline questionnaire in 2006, and were asked to complete a follow-up questionnaire 12 months later. The questionnaire included questions on substance use, including tobacco, alcohol, methamphetamine and cannabis use, demographic factors, and questions relating to school attendance and performance. RESULTS: Forty-three percent of the students surveyed at baseline did not complete a follow-up questionnaire after 12 months. Compared with students who were not using selected substances, an adjusted logistic regression model showed that life-time methamphetamine use in addition to other substances was significantly associated with non-attendance (OR = 2.58, 95% CI: 1.24 - 5.36) when other non-substance use factors (repeating a year at school and being older than the norm for current grade) were taken into account. CONCLUSIONS: Early identification of students with methamphetamine and other substance use problems, and a supportive rather than punitive school policy, may be valuable in improving high school completion and student retention rates.
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    Secular trends in risk behaviour of Cape Town grade 8 students
    (2006) Flisher, Alan J; Mathews, Catherine; Mukoma, Wanjiru; Lombard, Carl J
    Objective. To compare prevalence rates of selected risk behaviours and age of first intercourse of grade 8 students in Cape Town between 1997 and 2004. Design. Cross-sectional surveys in 1997 and 2004. Survival analysis was used to estimate the cumulative incidence of first intercourse. The log-rank statistic was used to compare the survival distributions. When comparing data from the two studies we used a logistic regression model with the factors year, race and age group to test the difference in reported risk behaviours between 1997 and 2004 within each gender. Setting. Public high schools in Cape Town. Subjects. Multistage cluster samples of 1 437 and 6 266 grade 8 students in 1997 and 2004 respectively. Outcome measures. Ever having had sexual intercourse; for those that had, whether any method was used to prevent pregnancy or disease at last intercourse, and (if so) what was used; use of tobacco, alcohol and marijuana; violence-related behaviours; and suicidal behaviour. Results. There was a significant delay in first intercourse in 2004 compared with 1997. For males, levels of condom use were lower in 2004 than in 1997, while for females levels of injectable contraceptive use were lower. There were significant increases in past month use of cigarettes for males and marijuana for both genders. Rates of perpetration of violence behaviour remained stable or decreased from 1997 to 2004, while the rate of suicidal behaviour for males increased. Conclusions. School-based interventions that address sexual risk behaviours should be expanded to include other risk behaviours.