Browsing by Author "Odayar, Jasantha"
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- ItemOpen AccessBreastfeeding practices among women living with HIV who started antiretroviral therapy in pregnancy in Cape Town South Africa(2023) Nqeto, Kanyo Naledi; Odayar, JasanthaMental illness as a determinant of non-adherence to breastfeeding recommendations among women living with Human Immunodeficiency Virus (HIV) remains an understudied phenomenon in low- and middle-income countries like South Africa. Our aim was to investigate the relationship between postpartum women living with HIV experiencing mental illness and adherence to breastfeeding practices as per the World Health Organization standards (WHO) in Cape Town, South Africa. Methods A secondary analysis was performed on data from 411 women living with HIV (WLHIV) who initiated ART in pregnancy. The women had participated in the 2016 – 2018 Postpartum Adherence Clubs for Antiretroviral Therapy (PACART) trial, which compared viral suppression up to 24 months postpartum in women randomized to two different models of HIV care. All 411 women were examined for the incidence of breastfeeding initiation and its association with postnatal depression using a bivariate analysis and a log-binomial regression. We also examined factors associated with breastfeeding duration and compared this duration in women at high risk of depression and those who were at low risk, using the cox proportion hazard model, Kaplan-Meier curves and the log rank test. Breastfeeding practices were assessed through an administered questionnaire and the Edinburgh postnatal depression scale had been used to identify the risk of depression. All women in the PACART trial were eligible for our study. Results A large proportion of mothers initiated breastfeeding within 72 hours postpartum, and this was similar among those with an increased risk of postnatal depression (n=99; 96.1%) and those with a decreased risk of postnatal depression (n=300; 97.4%). No significant factors were found that were associated with breastfeeding. Breastfeeding duration was similar in women at high risk of postnatal depression (91 days; interquartile range [IQR] 30 – 180) and those at low risk of postnatal depression (90 days; IQR 1 – 180), and this was not statistically significant (p-value = 0.69). Furthermore, we found no factors associated with breastfeeding duration. Conclusion We found no association between risk of postnatal depression and breastfeeding among women living with HIV initiating ART in pregnancy. Though breastfeeding initiation was at an optimal level, the duration was short indicating non-adherence to WHO standards. More effort needs to be made to address breastfeeding non-adhere
- ItemOpen AccessImpact of Unintended pregnancy on HIV viral load outcomes among postpartum women living with HIV in Cape Town, South Africa: clues from postpartum adherence clubs for antiretroviral therapy trial(2022) Mwalye, Pumulo Justine; Odayar, Jasantha; Brittain, KirstyIntroduction: Postpartum women living with HIV (WLWHIV) on antiretroviral therapy (ART) are at high risk of viraemia. We examined the association between unintended pregnancy and HIV viral load (VL) at 24 months postpartum in Cape Town, South Africa. Methods: Data are from a randomised trial that compared different ART delivery modalities for postpartum women aged at least 18 years who had initiated ART during their most recent pregnancy, had a VL<400 copies/ml in the previous three months, and had no comorbidities necessitating regular clinical follow-up. Pregnancy intentions regarding the most recent pregnancy were self-reported at enrolment into the study. VL was measured at 24 months postpartum, with elevated VL defined as VL≥1000 copies/ml. Chi-squared tests and logistic regression were used to examine predictors of unintended pregnancy. The impact of unintended pregnancy on elevated VL was examined using Poisson regression models. Results: Among 411 women included in the analysis (mean age: 28.7 years, 42% married/cohabiting, 75% with a parity≥2, and 86% with a VL<50 copies/ml), 57% reported that their most recent pregnancy was unintended. Compared to women aged 18-24 years, older women had a lower relative odds of unintended pregnancy [25-28 years, adjusted odds ratio (AOR): 0.34; 95% confidence interval (CI): 0.17-0.70; 29-34 years, AOR: 0.18; CI: 0.08-0.37; and ≥35 years, AOR: 0.35; CI: 0.14-0.89]. Additionally, unintended pregnancy was associated with being unmarried/not cohabiting (AOR: 4.44; CI: 2.78-7.09) and with higher parity (compared to parity=1: parity=2, AOR: 3.47; 95% CI: 1.86-6.50; and parity≥3, AOR: 6.38; 95% CI: 3.06-13.28). VL data at 24 months postpartum were available for 89% (366/411) of participants of whom 24% had elevated VL≥1000 copies/ml. Unintended pregnancy was associated with elevated VL in unadjusted analyses [risk ratio (RR): 1.54; CI: 1.03-2.28; p=0.032]. After adjustment for maternal factors and trial allocation, the association persisted despite not reaching statistical significance (adjusted risk ratio (aRR): 1.36; CI: 0.88-2.08; p=0.158). Conclusion: Among postpartum WLWHIV in South Africa, unintended pregnancy is prevalent and could be a risk factor for elevated VL. Reproductive health counselling and support during routine care visits may reduce unintended pregnancies and its effects.
- ItemOpen AccessIncidence and distribution of human leptospirosis in the Western Cape Province, South Africa, (2010-2019): a retrospective study(2022) Gizamba, Jacob Mugoya; Odayar, Jasantha; Dlamini, Sipho; Paul, LynthiaBackground Leptospirosis is an emerging zoonotic infection of global importance. Among humans, the infection is associated with varying clinical manifestations ranging from mild selflimiting febrile illness to severe illness mainly characterized by pulmonary hemorrhagic syndrome and acute kidney injury due to Weil's disease. In addition, leptospirosis presents with symptoms that mimic commonly known infections that cause febrile illnesses such as malaria, influenza, hepatitis, yellow fever, and viral hemorrhagic diseases. This has consequently, led to under-estimation of the burden of leptospirosis hence contributing to it neglected status. The burden of leptospirosis is reported to be substantially high in tropical regions and resource limited settings. In Africa, few countries have data and reports on human leptospirosis and research studies are scarce. In South Africa, the infection is an important underreported public health concern however information on the incidence trend and distribution of the infection is lacking. Yet such epidemiological description is essential for effective prevention of the infection. This study aimed at determining the incidence of Human Leptospirosis from 2010 to 2019, and to compare the incidence based on seasonal and demographic factors in Western Cape Province (WCP), South Africa. Methods The study was a retrospective secondary analysis of all data on ELISA IgM tests that were positive for leptospirosis between January 2010 and December 2019 in WCP, South Africa. Data was obtained from the National Health Laboratory Services (NHLS), where all serological tests on serum samples of patients who are clinically suspected to be having a leptospirosis infection are conducted. All leptospirosis positive results were grouped, and the incidence proportion of leptospirosis estimated according to sex, age, season, and year of occurrence. The provincial population sizes were used as the denominator when estimating the incidence and it was expressed as leptospirosis cases per 100,000 population. Negative binomial regression was used to estimate the effect of sex, year of occurrence and season on the incidence of human leptospirosis over the study period. The results were presented as incidence rate ratios (IRR) with 95% confidence intervals (CI). Results A total of 254 cases of human leptospirosis were recorded by the NHLS in the WCP, South Africa between 2010 and 2019. The highest number of cases was recorded in 2015 (42 cases, 16.5%) and lowest in 2012 (9 cases, 3.5%). The incidence of leptospirosis fluctuated widely across all the 10 years with the annual incidence ranging between 0.15 and 0.66 per 100,000 population and an average annual incidence of 0.40 per 100,000 population. The incidence was significantly higher among males compared to females (0.55 and 0.25 per 100,000 population respectively; incidence rate ratio (IRR) 2.2, 95% CI: 1.66,3.03) and the overall male to female ratio was 2.14:1. The average incidence of leptospirosis was highest among the 18-44-year-old age cohort (0.56 cases per 100,000 population), and lowest among the ≤17-year-old age cohort (0.07 cases per 100,000 population). The 18-44 (IRR 8.0, 95% CI: 4.65,15.15) and ≥ 45 (IRR 7.4, 95% CI: 4.17,14.17) age cohorts were more at risk of infection compared to ≤17age cohort. The incidence proportion in fall, summer and spring seasons were slightly higher compared to what was observed in winter season. However, and there was no significant association between season and incidence of leptospirosis. Conclusions The incidence of leptospirosis widely fluctuated between 2010 and 2019, with males and those above 18 years of age substantially at risk of infection. The results show that leptospirosis is an important zoonotic disease within the province and potentially disproportionately affecting males and the productive age demographic groups. These findings emphasize the need to enhance targeted prevention strategies and provoke further investigation on the importance of environmental and socioeconomic factors on the occurrence of leptospirosis within Western Cape Province and South Africa at large.
- ItemOpen AccessPatterns, predictors and outcomes of patient transfer in public sector chronic primary care services(2025) Odayar, Jasantha; Myer, BenjaminBackground: To maintain long-term care, patients with chronic conditions may require transfers between health facilities, jeopardising continuity of care. High levels of geographic mobility in low-and middle-income countries mean that patients may require transfers between primary health care (PHC) facilities. In addition, with decentralisation of chronic care services in many settings there are increasing numbers of PHC facilities between which patients can transfer. However, research on transfers between PHC facilities is limited. This thesis investigated transfers between PHC facilities of stable patients with chronic conditions in South Africa using HIV and diabetes as exemplars. Methods: First, national guidelines were reviewed for recommendations regarding transfers of people living with HIV (PLH). Second, routinely collected data from across the Western Cape were used to determine transfer incidence and outcomes among PLH and people living with diabetes (PLD). Third, at a PHC facility in Cape Town, medical records of PLH transferring in from any PHC facility in the province were reviewed to compare features of silent (health facility not informed of transfer, transfer letter not obtained) and official (health facility informed, transfer letter obtained) transfers. Fourth, in a trial of antiretroviral therapy (ART) delivery strategies among postpartum women, data were obtained from questionnaires (demographics and travel history) and in-depth interviews exploring barriers to transfer. Findings: Recommendations regarding management of transfers between PHC facilities were limited, particularly for silent transfers. Transfers between PHC facilities occurred frequently among PLH and PLD and were associated with viraemia and raised HbA1c results respectively. Among PLH transferring into a PHC facility, 52% had interrupted ART and 30% had clinical concerns; these percentages were higher among silent than official transfers. Among postpartum women, poor relationships with healthcare providers led to silent transfers; barriers to successful transfer included fear of community stigma and limited knowledge of transfer options and processes including for mobile women. Conclusions: Considering the volume and outcomes of transfers among PLH and PLD, routine monitoring and reporting of the number of transfers and transfer outcomes should be considered. Research on interventions to improve transfer outcomes and on transfers among people with other chronic conditions is warranted
- ItemOpen AccessPostpartum contraceptive use in HIV-positive women who started antiretroviral therapy in pregnancy in Cape Town(2024) Shuuya, Reginald; Odayar, JasanthaObjective: This study described factors associated with at least one episode of unmet need for contraception up to 24 months postpartum in women who began ART during pregnancy in Gugulethu, Cape Town. Methods: This was a retrospective review of data from a broader trial of antiretroviral drug delivery to women living with HIV during the postpartum period. Between 11 January 2016 and 10 November 2017, a total of 409 women living with HIV who had been on ART for at least three months, were at least 18 years old and within 28 days of delivery were participated in the study. Interviews were conducted to get information on family planning use and pregnancy intentions. The proportion of women who do not want to get pregnant in the future and in the next 12 months and are not using contraception was used to estimate the unmet demand for contraception. The factors associated with unmet need for contraception up to 24 months postpartum in women who began ART during pregnancy were investigated using binary logistic regression. The outcome of interest is the episode of unmet need for contraception. Results: Contraceptive use was high at each visit with the uptake of 97.80% at the first visit (enrolment). The overall prevalence of unmet family planning need was 19.60%. Women who are not married in this study were (OR=2.09, 95% CI: 1.26-3.47) more likely to have an unmet need for family planning and women who had been pregnant twice or more were (OR=2.24, 95% CI: 1.66-3.03) more likely to have an unmet need for family planning compared to the once who had been pregnant once. Conclusion: Contraceptive use among these women was high. The findings highlight that unmet need remains a source of concern in unmarried women and those who have been pregnant more than once. The findings can help drive national public health strategies to meet unmet contraceptive needs in women living with HIV through improving family planning initiatives and more effectively integrating family planning services into HIV treatment facilities.
- ItemOpen AccessPrevalence, predictors, and association of probable non-specific psychological distress and depression with HIV viral load among postpartum women in Cape Town, South Africa(2022) Arendse, Gwendoline; Myer, Landon; Odayar, JasanthaBackground: Psychological distress and depressive symptoms are prevalent among postpartum women living with HIV and may affect engagement in HIV care. We examined the prevalence and predictors of probable non-specific psychological distress and depressive symptoms and their association with elevated viral load (VL) in Cape Town, South Africa. Methods: This was a secondary analysis of data from the Postpartum Adherence Clubs for Antiretroviral Therapy trial which enrolled women who were initiated on antiretroviral therapy during the index pregnancy, had a VL 1000 copies/mL) through 24 months postpartum. Results: Among 401 women, 8% and 5% had elevated levels of psychological distress and depression, respectively. After adjusting for socio-demographic, obstetric, maternal, and HIV-related covariates, completion of some high school (adjusted odds ratio [aOR] 0.06; 95% confidence interval [CI] 0.01–0.55) and multiple infant delivery (aOR 12.82; 95% CI 1.25–127.11) were associated with elevated levels of psychological distress. Depressive symptoms were not associated with any of the covariates in an adjusted model. Neither psychological distress nor depressive symptoms were independently associated with viraemia at 24 months postpartum in a multivariable model. There were no significant differences between women with and without mental health-related outcomes in the time to elevated VL through 24 months postpartum. Conclusion: Non-specific psychological distress and depression remain prevalent among postpartum women living with HIV. Further research should explore the longitudinal effect of mental health-related outcomes and VL and interventions should be implemented to improve mental health-related problems in this population.