Browsing by Author "Moyo, Sizulu"

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    Childhood mortality in the Boland Overberg region
    (2007) Moyo, Sizulu; Mahomed, Hassan; Groenewald, Pam; Hawkridge, Anthony
    The aim of this thesis is to characterise the profile of infant, childhood and adolescent mortality in three adjancent district municipalities in the Boland region of the Western Cape Province of South Africa.
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    Exploring the relationship between sexual risk behaviours and HIV Status awareness among men in South Africa: analysis of data from the 2017 South African National house-based HIV prevalence, incidence and behaviour survey
    (2025) Nhlabatsi, Zanele; Phillips, Tamsin; Moyo, Sizulu
    South Africa has one of the highest HIV prevalence rates globally, with men being a key population at risk due to risky sexual behaviours and lower HIV status awareness compared to women. This study explored the relationships between sexual risk behaviours and HIV status awareness among 1,630 sexually active South African men (≥15 years, median age 34 years, interquartile range 24-44) using data from the 2017 South African National House-based HIV Prevalence, Incidence, and Behaviour Surveys (SABSSMV). Overall, 13.5% of men self-reported living with HIV (srHIV+) and there was high concordance between self-reported and laboratory confirmed HIV status with 92.0% (95% confidence interval [CI] 84.1% - 96.1%) and 88.0% (95% CI 85.5% - 90.2%); p<0.001, of men srHIV+ and those self-reporting not living with HIV (srHIV-) being laboratory confirmed, respectively. In total, 68.3% (95% CI 64.6% - 71.8%) of men reported casual sexual partners ( 48.2% [95% CI 39.0% - 57.5%] among men srHIV+ vs. 71.4% [95% CI 67.4% - 75.2%] among men srHIV-); p<0.001, 4.9% (95% CI 3.6% - 6.7%) reported ≥2 sexual partners (2.6% [95% CI 1.1% - 6.2%] vs. 5.3% [95% CI 3.8% - 7.4%]); p = 0.116, 26.5% (95% CI 23.4% - 29.9%) reported inconsistent condom use at last sex with all partners in the past year (23.3% [16.0% - 32.7%] vs. 27.0% [95% CI 23.6% - 30.8%]); p = 0.430, and 14.2% (95% CI 11.8% - 17.1%) reported alcohol use at last sex (16.9% [95% CI 10.9% - 25.1%] vs. 13.8% [11.3% - 16.9%]); p = 0.431, with values in brackets showing the proportion among those (srHIV+) versus (srHIV-), respectively. In logistic regression models, men (srHIV+) were less likely to report engaging in casual sex compared to men (srHIV-) ( (adjusted odds ratio 0.51 95% CI: 0.27–0.97). Variations in sexual risk behaviours were observed by demographic characteristics, and age appeared to modify the association between reported HIV status and some risk behaviours. The findings highlight the impact of HIV status on risky sexual behaviour, emphasizing the need for comprehensive HIV testing and counselling (HTC), safe sex education, and integrated behavioural and structural approaches in healthcare. Tailored interventions such as age-specific messaging, accessible educational content, ensuring condom and PrEP availability, youth-friendly tech-based solutions like online counselling or mobile apps, and public campaigns promoting safe sexual practices, will be essential to address the unique needs of different age groups, education levels, HIV statuses, and geographic settings.
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    Isolation of Non-Tuberculous Mycobacteria in Children Investigated for Pulmonary Tuberculosis
    (Public Library of Science, 2006) Hatherill, Mark; Hawkridge, Tony; Whitelaw, Andrew; Tameris, Michele; Mahomed, Hassan; Moyo, Sizulu; Hanekom, Willem; Hussey, Gregory
    Objective To evaluate the frequency and clinical significance of non-tuberculous mycobacteria (NTM) isolates among children investigated for pulmonary tuberculosis in a rural South African community. METHODS: Children were investigated for pulmonary tuberculosis as part of a tuberculosis vaccine surveillance program (2001-2005). The clinical features of children in whom NTM were isolated, from induced sputum or gastric lavage, were compared to those with culture-proven M. tuberculosis . RESULTS: Mycobacterial culture demonstrated 114 NTM isolates from 109 of the 1,732 children investigated, a crude yield of 6% (95% CI 5-7). The comparative yield of positive NTM cultures from gastric lavage was 40% (95% CI 31-50), compared to 67% (95% CI 58-76) from induced sputum. 95% of children with NTM isolates were symptomatic. Two children were HIV-infected. By contrast, M. tuberculosis was isolated in 187 children, a crude yield of 11% (95% CI 9-12). Compared to those with culture-proven M. tuberculosis , children with NTM isolates were less likely to demonstrate acid-fast bacilli on direct smear microscopy (OR 0.19; 95% 0.0-0.76). Children with NTM were older (p<0.0001), and more likely to demonstrate constitutional symptoms (p = 0.001), including fever (p = 0.003) and loss of weight or failure to gain weight (p = 0.04), but less likely to demonstrate a strongly positive tuberculin skin test (p<0.0001) or radiological features consistent with pulmonary tuberculosis (p = 0.04). DISCUSSION: NTM were isolated in 6% of all children investigated for pulmonary tuberculosis and in more than one third of those with a positive mycobacterial culture. NTM may complicate the diagnosis of PTB in regions that lack capacity for mycobacterial species identification. The association of NTM isolates with constitutional symptoms suggestive of host recognition requires further investigation.
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    Loss from treatment for drug resistant tuberculosis: risk factors and patient outcomes in a community-based program in Khayelitsha, South Africa
    (Public Library of Science, 2015) Moyo, Sizulu; Cox, Helen S; Hughes, Jennifer; Daniels, Johnny; Synman, Leigh; De Azevedo, Virginia; Shroufi, Amir; Cox, Vivian; Van Cutsem, Gilles
    BACKGROUND: A community based drug resistant tuberculosis (DR-TB) program has been incrementally implemented in Khayelitsha, a high HIV and TB burden community in South Africa. We investigated loss from treatment (LFT), and post treatment outcomes of DR-TB patients in this setting. METHODOLOGY: LFT, defined as interruption of treatment for ≥2 consecutive months was assessed among patients initiating DR-TB treatment for the first time between January 2009 and July 2011. Patients were traced through routine data sources to identify those who subsequently restarted treatment and those who died. Additional information on patient status and survival after LTF was obtained from community DR-TB counselors and from the national death registry. Post treatment outcomes were observed until July 2013. RESULTS: Among 452 patients initiating treatment for the first time within the given period, 30% (136) were LFT, with 67% retention at 18 months. Treatment was restarted in 27 (20%) patients, with additional resistance recorded in 2/25 (8%), excluding two with presumed DR-TB. Overall, 34 (25%) patients died, including 11 who restarted treatment. Males and those in the age category 15-25 years had a greater hazard of LFT; HR 1.93 (95% CI 1.35-2.75), and 2.43 (95% CI 1.52-3.88) respectively. Older age (>35 years) was associated with a greater hazard of death; HR 3.74 (1.13- 12.37) post treatment. Overall two-year survival was 62%. It was lower (45%) in older patients, and was 92% among those who received >12 months treatment. CONCLUSION: LFT was high, occurred throughout the treatment period and was particularly high among males and those aged 15-25 years. Overall long term survival was poor. High rates of LFT should however not preclude scale up of community based care given its impact in increasing access to treatment. Further research is needed to support retention of DR-TB patients on treatment, even within community based treatment programs.
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    Optimal tuberculosis case-finding methodologies for field trials of new tuberculosis vaccines in young children
    (2013) Moyo, Sizulu; Hussey, Gregory; Hatherill, Mark; Verver, Suzanne
    There is paucity of evidence to guide case-finding strategies in field trials of new tuberculosis vaccines conducted in young children. To investigate case-finding and case detection methods for tuberculosis in tuberculosis field trials conducted in young children.
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    Time to ART initiation among patients treated for rifampicin-resistant tuberculosis in Khayelitsha, South Africa: impact on mortality and treatment success
    (Public Library of Science, 2015) Daniels, Johnny Flippie; Khogali, Mohammed; Mohr, Erika; Cox, Vivian; Moyo, Sizulu; Edginton, Mary; Hinderaker, Sven Gudmund; Meintjes, Graeme; Hughes, Jennifer; De Azevedo, Virginia; van Cutsem, Gilles; Cox, Helen Suzanne
    Setting Khayelitsha, South Africa, with high burdens of rifampicin-resistant tuberculosis (RR-TB) and HIV co-infection. Objective To describe time to antiretroviral treatment (ART) initiation among HIV-infected RR-TB patients initiating RR-TB treatment and to assess the association between time to ART initiation and treatment outcomes. Design A retrospective cohort study of patients with RR-TB and HIV co-infection not on ART at RR-TB treatment initiation. RESULTS: Of the 696 RR-TB and HIV-infected patients initiated on RR-TB treatment between 2009 and 2013, 303 (44%) were not on ART when RR-TB treatment was initiated. The median CD4 cell count was 126 cells/mm 3 . Overall 257 (85%) patients started ART during RR-TB treatment, 33 (11%) within 2 weeks, 152 (50%) between 2-8 weeks and 72 (24%) after 8 weeks. Of the 46 (15%) who never started ART, 10 (21%) died or stopped RR-TB treatment within 4 weeks and 16 (37%) had at least 4 months of RR-TB treatment. Treatment success and mortality during treatment did not vary by time to ART initiation: treatment success was 41%, 43%, and 50% among patients who started ART within 2 weeks, between 2-8 weeks, and after 8 weeks (p = 0.62), while mortality was 21%, 13% and 15% respectively (p = 0.57). Mortality was associated with never receiving ART (adjusted hazard ratio (aHR) 6.0, CI 2.1-18.1), CD4 count ≤100 (aHR 2.1, CI 1.0-4.5), and multidrug-resistant tuberculosis (MDR-TB) with second-line resistance (aHR 2.5, CI 1.1-5.4). CONCLUSIONS: Despite wide variation in time to ART initiation among RR-TB patients, no differences in mortality or treatment success were observed. However, a significant proportion of patients did not initiate ART despite receiving >4 months of RR-TB treatment. Programmatic priorities should focus on ensuring all patients with RR-TB/HIV co-infection initiate ART regardless of CD4 count, with special attention for patients with CD4 counts ≤ 100 to initiate ART as soon as possible after RR-TB treatment initiation.